The 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 narrative synthesis systematic literature review

Abstract

AbstractObjectivesAssess the impact of single rooms versus multioccupancy accommodation on inpatient health-care outcomes and processes.DesignSystematic review.SettingHospitals and secondary care units.ParticipantsInpatients receiving routine, emergency, high-dependency, or intensive care with a named type of hospital accommodation.Main outcome measuresQualitative synthesis of findings.ResultsOf 4,861 citations initially identified, 215 were deemed suitable for full-text review, of which 145 were judged to be relevant to this review. Five main method types were reported: 60 before - and-after comparisons, 75 contemporaneous comparisons, 18 qualitative studies of accommodation preferences, 10 evidence syntheses. 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, but no clearly consistent conclusions could be drawn about overall benefits of single rooms versus shared accommodation (multioccupancy rooms, bays, or wards). 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, men, older adults, children, and adolescents were more likely to prefer shared accommodation to avoid loneliness. While shared accommodation seemed to be the most cost-effective approach for construction, greater costs associated with building single rooms were small and likely to be recouped over time by other efficiencies.ConclusionsThe 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.SummaryWhat is already known on this topicThe effects of single rooms versus shared accommodation on hospital inpatients’ outcomes are not well understoodMany studies are qualitative or narrative because randomised controlled trials are not practical and most comparative studies have only become possible after relocation to new facilitiesThis systematic review investigated the potential range of impacts that inpatient single rooms and shared accommodation have on the health-care processes, outcomes, and costsWhat this study addsThe evidence, though extensive, revealed no clear advantage for one type of inpatient hospital accommodation for many of the areas assessed.There was weak evidence indicating advantages for single bedrooms in some areas, such as lower risk of hospital acquired infection in adult intensive care and a range of outcomes in neonatal intensive care.Most patients preferred single rooms for privacy and some preferred shared accommodation for avoiding loneliness.