Recently my colleagues and I completed a systematic review of the clinical evidence surrounding the need for single-bed hospital rooms, including those in the ICU and on medical/surgical non-ICU wards. A little background first: Since 2006, the Facility Guideline Institute (FGI), a nonprofit organization that works to develop guidelines for designing and building hospitals and other health care facilities, has recommended that “the maximum number of beds per room in a medical surgical nursing unit (i.e. non-intensive care unit) in a general hospital shall be one unless the necessity of a two-bed arrangement has been demonstrated in the functional program.” This guideline promulgated by FGI has since been adopted as “a mandate” in 35 U.S. states as of December 2015. New hospital construction and/or renovation now requires construction of single bed non-ICU hospital rooms. These guidelines have resulted in billions of dollars of expenditures for the construction of single patient hospital rooms.
What we found in our assessment, using accepted instruments for grading (Center for Evidence Based Medicine [CEBM] and Grading of Recommendations Assessment, Development and Evaluation [GRADE]), is that the clinical evidence supporting non-ICU single patient rooms in order to reduce infection rates, falls, medication errors, and to improve upon patient satisfaction is sorely lacking. In fact, the highest quality evidence did not support the use of single patient rooms for reducing infections or minimizing patient falls. Interestingly, simple and inexpensive concepts such as hand wash dispensers in each room had more of an impact than a single bed per room. The lowest quality evidence (i.e. expert opinion) supported the use of single patient rooms. We did find that ICU single bedded rooms are likely necessary mainly due to the condition and high acuity of care of the patient. An article with our findings is currently under review in a peer-reviewed journal.
When we suggested to FGI leadership that they might consider pulling this recommendation for additional study, we were told that this would likely not happen for another six years and that they were preparing a paper extolling the benefits of single patient rooms. What concerns me in this process is that much of the evidence pointing towards the lack of need of single non-ICU patient rooms was accessible to us from FGI’s website. In other words, their own evidence doesn’t support their recommendation.
So why is FGI reluctant to reconsider its guidelines or at least state that they are under review? It may be due to the medical industrial complex and a smugness that it knows best. Single patient rooms are, in my mind, nice to have, but based on the clinical evidence, not necessary. They can be used for marketing purposes for those who can afford it and who may want to pay a little extra. But in today’s environment of cost saving and quality care, we can provide quality care at a lower cost with non-ICU rooms having multiple beds in one room. This complies with the Affordable Care Act mandate and should be adhered to by all involved in our healthcare system.
