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Is single room hospital accommodation associated with differences in healthcare-associated infection, falls, pressure ulcers or medication errors? A natural experiment with non-equivalent controls

Originally Published:
2016
Key Points Summary
Key Point Summary Author(s):
Dickey, Andrew
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Key Concepts/Context
Previous studies have associated single-patient rooms with reduced infection rates, reduced medication errors, and faster patient recovery rates. In response, an increasing number of hospitals have been shifting towards an entirely single-patient room layout. Although there are plenty of studies from the U.K. providing empirical evidence for the efficacy of single-patient rooms, the United States lacks this foundation of published research, and could therefore benefit from an outcome analysis of single-patient rooms.
Objectives
To assess how the move to a newly built entirely single-room acute care hospital affects safety outcomes.
Methods
The efficacy of 100% single-room accommodation was measured through a before-and-after study using a facility that went from 10% to 100% single-room accommodation as the intervention site and two more traditional facilities as controls. The authors analyzed several patient safety event rates from all locations, including falls, pressure ulcers, and infection rates, along with other changes to underlying patient characteristics, such as length of stay and case mix. 
Design Implications
The results of this study indicate that there is no evidence of any inherent benefit or harm in the implementation of single-patient rooms. The implementation of single-patient rooms should therefore be founded on a specific purpose or rationale so that resources are not used on what may not be a cure-all solution that improves patient outcomes.
Findings
The switch to 100% single rooms revealed both positive and negative differences when compared to the more traditional facilities, but with little to no change in overall costs. The transition period in the intervention facility (shift from 10% single rooms to 100%) saw a spike in falls and medication errors, but these returned to pre-move levels within seven to nine months. Within this same period, length of stay also increased from 1.2 to 1.4 days. MRSA infections decreased from 279 cases in 2010 to 92 cases in 2012 at the intervention site. The authors speculate that the increase in adverse safety events witnessed in the intervention site was likely due to the introduction of new workflows rather than the nature of the single rooms themselves.
Limitations
The authors note that the ideal situation for this study would have been a larger sample of hospitals that featured multiple moves. They also note that it was only possible to use aggregated data without individual risk adjustments, as all of the safety events data were not linked to individual patient characteristics. Lastly, the authors realize that while the definitions of “incidents” are standardized, the approaches to gathering data on them may not be.
Conceptual Models

The following links are conceptual models. Models outline design features that are potentially linked to health outcomes. They are not a representation of data from a specific article, but rather conceptual models for design features linked to health outcomes. The purpose of these models is to provide a broader context within which to read articles within this design category and to make related design or policy decisions.

Setting
Hospitals
Outcome Category
Patient health outcomes
Environmental Condition Category
Physical proximity/density
Primary Author
Simon, M.