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Bertuzzi A, Martin A, Clarke N, Springate C, Ashton R, Smith W, Orlowski A, McPherson D. Clinical, humanistic and economic outcomes, including experiencing of patient safety events, associated with admitting patients to single rooms compared with shared accommodation for acute hospital admissions: a systematic review and narrative synthesis. BMJ Open 2023; 13:e068932. [PMID: 37147093 PMCID: PMC10163491 DOI: 10.1136/bmjopen-2022-068932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2023] Open
Abstract
OBJECTIVES Assess the impact of single rooms versus multioccupancy accommodation on inpatient healthcare outcomes and processes. DESIGN Systematic review and narrative synthesis. DATA SOURCES Medline, Embase, Google Scholar and the National Institute for Health and Care Excellence website up to 17 February 2022. ELIGIBILITY CRITERIA Eligible papers assessed the effect on inpatients staying in hospital of being assigned to a either a single room or shared accommodation, except where that assignment was for a direct clinical reason like preventing infection spread. DATA EXTRACTION AND SYNTHESIS Data were extracted and synthesised narratively, according to the methods of Campbell et al. RESULTS: Of 4861 citations initially identified, 145 were judged to be relevant to this review. Five main method types were reported. All studies had methodological issues that potentially biased the results by not adjusting for confounding factors that are likely to have contributed to the outcomes. Ninety-two papers compared clinical outcomes for patients in single rooms versus shared accommodation. No clearly consistent conclusions could be drawn about overall benefits of single rooms. Single rooms were most likely to be associated with a small overall clinical benefit for the most severely ill patients, especially neonates in intensive care. Patients who preferred single rooms tended to do so for privacy and for reduced disturbances. By contrast, some groups were more likely to prefer shared accommodation to avoid loneliness. Greater costs associated with building single rooms were small and likely to be recouped over time by other efficiencies. CONCLUSIONS The lack of difference between inpatient accommodation types in a large number of studies suggests that there would be little effect on clinical outcomes, particularly in routine care. Patients in intensive care areas are most likely to benefit from single rooms. Most patients preferred single rooms for privacy and some preferred shared accommodation for avoiding loneliness. PROSPERO REGISTRATION NUMBER CRD42022311689.
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Affiliation(s)
| | | | | | | | - Rachel Ashton
- Ashton Editorial Consulting, London, UK
- The Health Economics Unit, NHS England and NHS Improvement Midlands, West Bromwich, UK
| | - Wayne Smith
- The Health Economics Unit, NHS England and NHS Improvement Midlands, West Bromwich, UK
| | - Andi Orlowski
- The Health Economics Unit, NHS England and NHS Improvement Midlands, West Bromwich, UK
- Department of Primary Care and Public Health, Imperial College London, London, UK
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Parm Ü, Tiit-Vesingi A, Soeorg H, Štšepetova J, Truusalu K, Vorobjov S, Lutsar I, Metsvaht T. Effect of early directed implementation of family-integrated care measures on colonisation with Enterobacteriaceae in preterm neonates in NICU. BMJ Paediatr Open 2023; 7:10.1136/bmjpo-2022-001712. [PMID: 37192777 DOI: 10.1136/bmjpo-2022-001712] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 03/22/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Hospital-acquired strains (HASs) and multiresistant strains in neonatal intensive care unit often harbour virulence and resistance mechanisms, carrying the risk of invasive infections. We describe colonisation with Enterobacteriaceae in neonates receiving early directed versus routine family-integrated care (FIC) within the first month of life. METHODS A prospective cohort study included neonates with a gestational age below 34 weeks. During the first period, neonates were admitted to an open bay unit with transfer to the single-family room if available; feeding with the mother's own breast milk (MOBM) was introduced within 24 hours, and skin-to-skin contact (SSC) within 5 days of life (the routine care group). During the second period, following a wash-in of 2 months, care in a single-family room within 48 hours, the introduction of MOBM within two and SSC in 48 hours were applied (the intervention group). Enterobacteriaceae isolated from neonatal stool, breast milk and parental skin swabs were genotyped, Simpson's Index of Diversity (SID) calculated, and extended-spectrum beta-lactamases (ESBL) detected. RESULTS In 64 neonate-parents' groups, 176 Enterobacteriaceae, 87 in routine care and 89 in the intervention group were isolated; 26 vs 18 were HAS and one vs three ESBL positive, respectively. In the intervention group compared with the routine care group, SSC and MOBM feeding was started significantly earlier (p<0.001); during the first week of life, time spent in SSC was longer (median hours per day 4.8 (4-5.1) vs 1.9 (1.4-2.6), p<0.001) and the proportion of MOBM in enteral feeds was higher (median (IQR) 97.8% (95.1-100) vs 95.1% (87.2-97.4), p=0.011). Compared with the routine care group, the intervention group had higher SID and a reduction of HAS by 33.1% (95% CI 24.4% to 42.4%) in time series analysis. CONCLUSIONS Early implementation of FIC measures may hold the potential to increase diversity and reduce colonisation with HAS Enterobacteriaceae.
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Affiliation(s)
- Ülle Parm
- Department of Microbiology, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
| | - Annika Tiit-Vesingi
- Department of Microbiology, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
- Neonatal Intensive Care Unit, East Tallinn Central Hospital, Tallinn, Estonia
| | - Hiie Soeorg
- Department of Microbiology, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
| | - Jelena Štšepetova
- Department of Microbiology, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
| | - Kai Truusalu
- Department of Microbiology, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
| | - Sigrid Vorobjov
- Department of Risk Behaviour Studies, National Institute of Health Development, Tallinn, Estonia
| | - Irja Lutsar
- Department of Microbiology, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
| | - Tuuli Metsvaht
- Department of Microbiology, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
- Paediatric and Neonatal Intensive Care Unit, Clinic of Anaesthesiology and Intensive Care, Tartu University Hospital, Tartu, Estonia
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Gregersen M, Mellemkjær A, Foss CH, Blandfort S. Use of single-bed rooms may decrease the incidence of hospital-acquired infections in geriatric patients: A retrospective cohort study in Central Denmark region. J Health Serv Res Policy 2021; 26:282-288. [PMID: 33586483 DOI: 10.1177/1355819621994866] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Patients accommodated in single-bed rooms may have a reduced risk of hospital-acquired infections (HAIs) compared to those in multi-bed rooms. This study aimed to examine the effect of single-bed accommodation on HAIs in older patients admitted to a geriatric ward. METHODS A retrospective cohort study of patients admitted to geriatric wards in a university hospital in Central Denmark Region linked to a move to a newly built hospital, involving all consecutively admitted patients aged 65 years and over from 15 September to 19 December 2016 and a similar cohort admitted in the same three months in 2017. We compared the incidence of HAIs in patients in single-bed accommodation to those in multi-bed accommodation using retrospective review of electronic patient records, with all infections verified microbiologically or by X-ray with onset between 48 hours after admission to 48 hours after discharge from hospital. RESULTS In total 446 patients were included. The incidence of HAIs in multi-bed accommodation was 30% compared to 20% in single-bed accommodation. The hazard ratio was 0.62 (95% Confidence Interval 0.43-0.91, p = 0.01) for single-bed accommodation. This finding remained robust after adjustment for age, sex, infection at admission, risk of sepsis, use of catheter, treatment with prednisone or methotrexate, and comorbidity index. CONCLUSION Accommodation in single-bed rooms appeared to reduce HAIs compared to multi-bed rooms in two geriatric wards. This finding should be considered as hypothesis-generating and be examined further using an experimental design.
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Affiliation(s)
- Merete Gregersen
- Clinical Nurse Specialist, Associate Professor, Department of Geriatrics, Aarhus University Hospital, Denmark
| | - Anders Mellemkjær
- Physician, Department of Geriatrics, Aarhus University Hospital, Denmark
| | - Catherine H Foss
- Physician, Department of Geriatrics, Aarhus University Hospital, Denmark
| | - Sif Blandfort
- Registered Nurse, Department of Geriatrics, Aarhus University Hospital, Denmark
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Davis M, Elliott R, Hills R, Fry M. Single-Room Ward Design and Its Impact on Service and Patient Outcomes: An Evaluation Study. Orthop Nurs 2019; 38:317-325. [PMID: 31568120 DOI: 10.1097/nor.0000000000000593] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Evidence suggests that single-room inpatient wards are associated with better patient outcomes than open-room wards but little is known about the impact on adverse events, patient satisfaction, and clinician experiences. METHODS/PURPOSE We evaluated the impact of a new inpatient single-room orthopaedic ward on patient and clinician outcomes using a medical record audit; patient, nurse, and medical doctor surveys; and nonparticipant observations in a tertiary hospital in Sydney, Australia. RESULTS The audit (1,569 patients; 819 open-room ward and 750 new single-room ward) revealed unchanged adverse event rates and fewer emergency calls after the move to a single-room ward. Survey responses from nurses, medical doctors, and patients were positive. Observations suggested that clinicians devised solutions to potential threats to patient safety. CONCLUSION The single-room ward design did not negatively impact on patient and clinician outcomes and was preferred by them. Clinicians organized their work to ensure patient safety.
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Affiliation(s)
- Melissa Davis
- Melissa Davis, RN, BSc, GradCert, Royal North Shore Hospital, St. Leonards, New South Wales, Australia. Rosalind Elliott, RN, PhD, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia; and Research and Practice Development Unit, Nursing and Midwifery Directorate, Royal North Shore Hospital, Northern Sydney Local Health District, St. Leonards, New South Wales, Australia. Rosemary Hills, RN, Royal North Shore Hospital, St. Leonards, New South Wales, Australia. Margaret Fry, RN, PhD, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia; and Research and Practice Development Unit, Nursing and Midwifery Directorate, Royal North Shore Hospital, Northern Sydney Local Health District, St. Leonards, New South Wales, Australia
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Halaby T, Al Naiemi N, Beishuizen B, Verkooijen R, Ferreira JA, Klont R, Vandenbroucke-Grauls C. Impact of single room design on the spread of multi-drug resistant bacteria in an intensive care unit. Antimicrob Resist Infect Control 2017; 6:117. [PMID: 29177048 PMCID: PMC5688743 DOI: 10.1186/s13756-017-0275-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 11/08/2017] [Indexed: 11/28/2022] Open
Abstract
Background Cross-transmission of nosocomial pathogens occurs frequently in intensive care units (ICU). The aim of this study was to investigate whether the introduction of a single room policy resulted in a decrease in transmission of multidrug-resistant (MDR) bacteria in an ICU. Methods We performed a retrospective study covering two periods: between January 2002 and April 2009 (old-ICU) and between May 2009 and March 2013 (new-ICU, single-room). These periods were compared with respect to the occurrence of representative MDR Gram-negative bacteria. Routine microbiological screening, was performed on all patients on admission to the ICU and then twice a week. Multi-drug resistance was defined according to a national guideline. The first isolates per patient that met the MDR-criteria, detected during the ICU admission were included in the analysis. To investigate the clonality, isolates were genotyped by DiversiLab (bioMérieux, France) or Amplified Fragment Length Polymorphism (AFLP). To guarantee the comparability of the two periods, the ‘before’ and ‘after’ periods were chosen such that they were approximately identical with respect to the following factors: number of admissions, number of beds, bed occupancy rate, per year and month. Results Despite infection prevention efforts, high prevalence of MRD bacteria continue to occur in the original facility. A marked and sustained decrease in the prevalence of MDR-GN bacteria was observed after the migration to the new ICU, while there appear to be no significant changes in the other variables including bed occupancy and numbers of patient admissions. Conclusion Single room ICU design contributes significantly to the reduction of cross transmission of MRD-bacteria.
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Affiliation(s)
- Teysir Halaby
- Laboratory for Medical Microbiology and Public Health, Boerhaavelaan 59, 7555 BB Hengelo, The Netherlands
| | - Nashwan Al Naiemi
- Laboratory for Medical Microbiology and Public Health, Boerhaavelaan 59, 7555 BB Hengelo, The Netherlands.,Department of Medical Microbiology & Infection Control, VU University Medical Center, Amsterdam, The Netherlands.,Medical Microbiology and Infection Control, Ziekenhuisgroep Twente, Almelo, The Netherlands
| | - Bert Beishuizen
- Department of intensive care, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Roel Verkooijen
- Laboratory for Medical Microbiology and Public Health, Boerhaavelaan 59, 7555 BB Hengelo, The Netherlands
| | - José A Ferreira
- Department of Statistics, Informatics and Modelling, National Institute for Public Health and the Environment, RIVM, Bilthoven, The Netherlands
| | - Rob Klont
- Laboratory for Medical Microbiology and Public Health, Boerhaavelaan 59, 7555 BB Hengelo, The Netherlands.,Department of intensive care, Medisch Spectrum Twente, Enschede, The Netherlands
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Simon M, Maben J, Murrells T, Griffiths P. 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. J Health Serv Res Policy 2016; 21:147-55. [PMID: 26811373 PMCID: PMC4904344 DOI: 10.1177/1355819615625700] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES A wide range of patient benefits have been attributed to single room hospital accommodation including a reduction in adverse patient safety events. However, studies have been limited to the US with limited evidence from elsewhere. The aim of this study was to assess the impact on safety outcomes of the move to a newly built all single room acute hospital. METHODS A natural experiment investigating the move to 100% single room accommodation in acute assessment, surgical and older people's wards. Move to 100% single room accommodation compared to 'steady state' and 'new build' control hospitals. Falls, pressure ulcer, medication error, meticillin-resistant Staphylococcus aureus and Clostridium difficile rates from routine data sources were measured over 36 months. RESULTS Five of 15 time series in the wards that moved to single room accommodation revealed changes that coincided with the move to the new all single room hospital: specifically, increased fall, pressure ulcer and Clostridium difficile rates in the older people's ward, and temporary increases in falls and medication errors in the acute assessment unit. However, because the case mix of the older people's ward changed, and because the increase in falls and medication errors on the acute assessment ward did not last longer than six months, no clear effect of single rooms on the safety outcomes was demonstrated. There were no changes to safety events coinciding with the move at the new build control site. CONCLUSION For all changes in patient safety events that coincided with the move to single rooms, we found plausible alternative explanations such as case-mix change or disruption as a result of the re-organization of services after the move. The results provide no evidence of either benefit or harm from all single room accommodation in terms of safety-related outcomes, although there may be short-term risks associated with a move to single rooms.
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Affiliation(s)
- Michael Simon
- Tenure-Track Assistant Professor, Institute of Nursing Science, Faculty of Medicine, University of Basel, Basel, Switzerland Head of Nursing Research Unit, Directorate of Nursing/AHP, Inselspital Bern University Hospital, Bern, Switzerland
| | - Jill Maben
- Professor Florence Nightingale School of Nursing and Midwifery, King's College, London, UK
| | - Trevor Murrells
- Statistician, Florence Nightingale School of Nursing and Midwifery, King's College, London, UK
| | - Peter Griffiths
- Professor, Centre for Innovation and Leadership in Health Sciences & National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (Wessex), University of Southampton, Highfield Campus, Southampton UK
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Maben J, Griffiths P, Penfold C, Simon M, Pizzo E, Anderson J, Robert G, Hughes J, Murrells T, Brearley S, Barlow J. Evaluating a major innovation in hospital design: workforce implications and impact on patient and staff experiences of all single room hospital accommodation. HEALTH SERVICES AND DELIVERY RESEARCH 2015. [DOI: 10.3310/hsdr03030] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundNew hospital design includes more single room accommodation but there is scant and ambiguous evidence relating to the impact on patient safety and staff and patient experiences.ObjectivesTo explore the impact of the move to a newly built acute hospital with all single rooms on care delivery, working practices, staff and patient experience, safety outcomes and costs.Design(1) Mixed-methods study to inform a pre-/post-‘move’ comparison within a single hospital, (2) quasi-experimental study in two control hospitals and (3) analysis of capital and operational costs associated with single rooms.SettingFour nested case study wards [postnatal, acute admissions unit (AAU), general surgery and older people’s] within a new hospital with all single rooms. Matched wards in two control hospitals formed the comparator group.Data sourcesTwenty-one stakeholder interviews; 250 hours of observation, 24 staff interviews, 32 patient interviews, staff survey (n = 55) and staff pedometer data (n = 56) in the four case study wards; routinely collected data at ward level in the control hospitals (e.g. infection rates) and costs associated with hospital design (e.g. cleaning and staffing) in the new hospital.Results(1) There was no significant change to the proportion of time spent by nursing staff on different activities. Staff perceived improvements (patient comfort and confidentiality), but thought the new accommodation worse for visibility and surveillance, teamwork, monitoring, safeguarding and remaining close to patients. Giving sufficient time and attention to each patient, locating other staff and discussing care with colleagues proved difficult. Two-thirds of patients expressed a clear preference for single rooms, with the benefits of comfort and control outweighing any disadvantages. Some patients experienced care as task-driven and functional, and interaction with other patients was absent, leading to a sense of isolation. Staff walking distances increased significantly after the move. (2) A temporary increase in falls and medication errors within the AAU was likely to be associated with the need to adjust work patterns rather than associated with single rooms, although staff perceived the loss of panoptic surveillance as the key to increases in falls. Because of the fall in infection rates nationally and the low incidence at our study site and comparator hospitals, it is difficult to conclude from our data that it is the ‘single room’ factor that prevents infection. (3) Building an all single room hospital can cost 5% more but the difference is marginal over time. Housekeeping and cleaning costs are higher.ConclusionsThe nature of tasks undertaken by nurses did not change, but staff needed to adapt their working practices significantly and felt ill prepared for the new ways of working, with potentially significant implications for the nature of teamwork in the longer term. Staff preference remained for a mix of single rooms and bays. Patients preferred single rooms. There was no strong evidence that single rooms had any impact on patient safety but housekeeping and cleaning costs are higher. In terms of future work, patient experience and preferences in hospitals with different proportions of single rooms/designs need to be explored with a larger patient sample. The long-term impact of single room working on the nature of teamwork and informal learning and on clinical/care outcomes should also be explored.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Jill Maben
- National Nursing Research Unit, Florence Nightingale Faculty of Nursing and Midwifery (formerly Florence Nightingale School of Nursing and Midwifery), King’s College London, London, UK
| | - Peter Griffiths
- Centre for Innovation and Leadership in Health Sciences, University of Southampton, Southampton, UK
| | - Clarissa Penfold
- National Nursing Research Unit, Florence Nightingale Faculty of Nursing and Midwifery (formerly Florence Nightingale School of Nursing and Midwifery), King’s College London, London, UK
| | - Michael Simon
- Centre for Innovation and Leadership in Health Sciences, University of Southampton, Southampton, UK
| | - Elena Pizzo
- Imperial College Business School, London, UK
| | - Janet Anderson
- National Nursing Research Unit, Florence Nightingale Faculty of Nursing and Midwifery (formerly Florence Nightingale School of Nursing and Midwifery), King’s College London, London, UK
| | - Glenn Robert
- National Nursing Research Unit, Florence Nightingale Faculty of Nursing and Midwifery (formerly Florence Nightingale School of Nursing and Midwifery), King’s College London, London, UK
| | - Jane Hughes
- National Nursing Research Unit, Florence Nightingale Faculty of Nursing and Midwifery (formerly Florence Nightingale School of Nursing and Midwifery), King’s College London, London, UK
| | - Trevor Murrells
- National Nursing Research Unit, Florence Nightingale Faculty of Nursing and Midwifery (formerly Florence Nightingale School of Nursing and Midwifery), King’s College London, London, UK
| | - Sally Brearley
- National Nursing Research Unit, Florence Nightingale Faculty of Nursing and Midwifery (formerly Florence Nightingale School of Nursing and Midwifery), King’s College London, London, UK
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