Patients and staff disagree over benefits of single-room hospital accommodation

Research shows patients believe the advantages of 100% single rooms in hospital outweigh the disadvantages, whereas staff prefer a mix of single and multiple-bedded rooms

Patients preferred single-room environments, while staff opted for a mix of single rooms and multi-bed bays

The views of patients and staff differ on whether hospitals offering 100% single-room accommodation are better than those with traditional ward accommodation, a new study has revealed.

This week, researchers at King’s College London, launched a report published by the National Institute for Health Research on the impact of 100% single-occupancy hospitals on patients and staff.

The two-year evaluation, led by Professor Jill Maben, director of the National Nursing Research Unit at the Florence Nightingale Faculty of Nursing and Midwifery at King’s College London, provides some critical insights that could help to inform future innovations in hospital design across the UK.

The findings of the report show a mixed picture, with both patients and staff reporting advantages and disadvantages of 100% single occupancy rooms

And the results reveal that, while patients believe the advantages of single rooms outweigh the disadvantages, staff prefer a mix of the two.

Conducted by a team of researchers from three leading UK universities, the study explored the move from traditional Nightingale-style hospital wards to 100% single-room patient accommodation and evaluated the impact on care delivery, working practices, staff and patient experience, patient safety outcomes, and cost.

Increasingly, new hospital buildings are designed with a greater proportion of single-room accommodation and, in some cases, 100% single inpatient rooms. However, prior to this study, there has been little UK evidence relating to the impact of single rooms on patient safety and experience.

Researchers spent time gathering data and interviewing patients and staff, both before and after moving to a new, purpose-built hospital - where every room has a single bed and an en-suite bathroom. The research group’s findings now promise to inform how healthcare managers commission, design and build the hospitals of the future.

Overall, staff at the new hospital preferred the traditional mix of single rooms and bays to the 100% single occupancy design; reporting high levels of anxiety as they needed to make rapid changes to their working practices in order to monitor and access patients in the single rooms. They felt ill prepared for these changes and had to develop and trial new ways of working on the job.

Staff felt this meant they weren’t able to adapt as effectively or as quickly as they would have liked to the new environment, citing examples such as difficulty in monitoring more than one patient at a time and being unable to see patients who are at risk of falls when they got out of bed independently.

Staff also found it difficult to find each other and the decreased amount of contact with colleagues had an impact on team working, making it harder for them to observe their colleagues’ practise, quickly share ideas, or ask for assistance.

On the one hand, we have seen improved patient experience because of benefits such as privacy and noise reduction, while, one the other, some patients reported feeling isolated or lonely

Patients, however, generally reported higher levels of comfort in the single rooms, particularly in relation to the en-suite toilet facilities, lighting, ventilation, having a view from a window, and reduced noise levels. Patients also experienced a high degree of control in the single rooms; increased privacy and better confidentiality, being able to spend more fulfilling time with visitors and getting more uninterrupted sleep.

Some patients did report feeling isolated and missed the company of others, but overall the majority – two thirds - preferred single rooms, while 22% stated a preference for multi-bedded accommodation. Almost all of these in the latter category were male patients. The main reason given was interaction with other patients. All postnatal patients also expressed a preference for single-room accommodation.

Despite the concerns of staff, the study found no strong evidence that single rooms had an impact on patient safety outcomes.

Professor Jill Maben said: “The findings of the report show a mixed picture, with both patients and staff reporting advantages and disadvantages of 100% single occupancy rooms.

“On the one hand, we have seen improved patient experience because of benefits such as privacy and noise reduction, while, one the other, some patients reported feeling isolated or lonely.

“For staff the picture is even more complex. Nurses found it difficult to monitor multiple patients as they didn’t have a line of sight across a bay of beds and this was especially important for older vulnerable patients at risk of falling.”

Nurses found it difficult to monitor multiple patients as they didn’t have a line of sight across a bay of beds and this was especially important for older vulnerable patients at risk of falling

The evidence suggests that training and rehearsal of new ways of working in advance of the move may facilitate and possibly accelerate adaptation to single-room working, potentially improving the patient and staff experience and enhancing patient monitoring and surveillance.

The report, entitled Evaluating a major innovation in hospital design: workforce implications and impact on patient and staff experiences of all single room hospital accommodation, involved researchers from the Florence Nightingale Faculty of Nursing and Midwifery, the Centre for Innovation and Leadership in Health Sciences, the University of Southampton, and the Imperial College Business School, London. The project was funded by the National Institute for Health Research.

Click here to read the full report.