It's been more than 20 years since the healthcare design community started talking about single-bed patient rooms in hospitals.
I'm not exactly sure when the conversation started, but it may have begun shortly after 1996 when The Center for Health Design (CHD) published its first literature review, "An Investigation to Determine Whether the Built Environment Affects Patient's Medical Outcomes."
Only 48 Credible Studies
Back then, researchers found only 48 credible studies that linked the design of the physical environment to patient outcomes. Eight years later, when Roger Ulrich, Craig Zimring and colleagues conducted a second literature review for CHD, they found more than 400 studies.
They concluded that the evidence was strong enough to move away from double-bed patient rooms, citing studies about infections, privacy, and sleep quality.
The Ulrich-Zimring report was a catalyst for the Facilities Guidelines Institute (FGI) to commission the Coalition for Health Environments Research (CHER) to do a literature review in 2004.
That report, "The Use of Single Patient Rooms Versus Multiple Occupancy Rooms in Acute Care Environments," helped convince FGI's Guidelines Committee to recommend single patient rooms.
Single-Bed Patient Rooms Become a Mandate
In 2006, FGI put this language into its Guidelines for the Design and Construction of Health Care Facilities: “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.”
Many states have since adopted this guidelines as a mandate, which some believe have helped jack up the cost of design and construction.
"New hospital construction and/or renovation now requires construction of single bed non-ICU hospital rooms," Medical Device Consultant Jeff Voigt wrote in Wharton Magazine 2016. "These guidelines have resulted in billions of dollars of expenditures for the construction of single patient hospital rooms."
Billions Spent, Billions Saved
Although he doesn't back it up with any evidence, Voigt's statement may be true. He goes on to argue that there's not enough evidence to support the mandate for single bed patient rooms.
I'm not sure about that, either. Type in "single bed patient rooms" into CHD's Knowledge Repository, and 107 resources pop up.
That may not be enough to satisfy skeptics, but we need to judge the quality of the evidence, not just the quantity.
Too Hard to Measure
And I also wonder how many lives have been saved by not having two patients in a room sharing germs. Or how much money has been saved since 2006 by decreasing airborne and surface infections for patients in single rooms?
My guess is that it could also be in the billions.
Unfortunately, though, we have no way of knowing what that dollar figure is. Because it's too hard to measure.
There are so many variables that contribute to the spread of infections in patient rooms, including staff hand-hygiene (probably #1), cleaning and maintenance, and the quality of ventilation systems.
And while some studies show overall hospital infection rates decreasing, many of those infections are related to procedures (surgical-site, urinary tract) that have nothing to do with the environment.
But that's still good news.
And I haven't even touched on the patient experience. Because I bet most patients would prefer a single-bedded room over a double any day.
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