Single-patient hospital rooms don’t obviate need for attitude shifts on safety and quality

JAMA published an article Aug. 27 by Toronto doctors Michael Detsky and Edward Etchells called "Single-Patient Rooms for Safe Patient-Centered Hospitals." Abstract here. (As usual, JAMA does not allow free access to public policy articles. When will they start to do that, I wonder?)

Here’s the summary:

Clinicians should advocate for single-patient rooms in any new hospital construction, expansion, renovation, or redesign. Single-patient rooms are permanent physical features that potentially could improve safety and patient satisfaction without the need for ongoing staff training, audits, or reminders. Money spent on capital costs to improve patient care may be more efficient than money spent on changing hospital culture and the behavior and attitude of health professionals. It is not necessary to wait 50 years for existing hospital structures to deteriorate before the full potential of single-patient rooms can be realized.

I do not disagree about the attributes of single-patient rooms, in terms of infection control, patient satisfaction, and optimal use of rooms for a diverse mix of patients. Also, they are strongly recommended in guidelines of the American Institute of Architects. I believe they will result in higher capital costs (and therefore higher annual carrying costs), but I do not think it likely that they will generate savings or efficiencies commensurate with those capital costs. In other words, they may not have a good rate of return, in strict financial terms, but they clearly will be the standard for new construction and renovations.

But I think Detsky and Etchells are off-base in their conclusion about single-patient rooms obviating the need for improved staff performance in the quality arena. The idea that increased capital investment in this arena will result in a noticeable and sustained improvement in reducing harm in hospitals — absent ongoing and dedicated training, measurement, audits, and reminders — seems to me to be counterintuitive.

I am not sure why the authors felt they needed to reach so far with their conclusion. It ends up sounding like they really feel that the "behavior and attitude of health professionals" is perfectly fine and that it has been the existence of multi-patient rooms that has been the source of safety and patient satisfaction problems in those rooms. This type of conclusion does harm to the quality and safety movement in that it could be used as an excuse that would distract people from investing time and effort in process improvements that are almost universally acknowledged as being long overdue.

Paul Levy is the President and CEO of Beth Israel Deaconess Medical
Center in Boston. For the past year and a half he has blogged about his
experiences in an online journal, Running a Hospital, one of the few blogs we know of maintained by a senior hospital executive.

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