Single room occupancy as a minimum
Introduction
The Facility Guidelines Institute (FGI) has begun the process of revising the 2006 edition of the Guidelines for Design and Construction of Hospital and Health Care Facilities for the 2010 edition. The document is widely used by architects, engineers and health care professionals as a guideline, reference, codes and standards. The Guidelines are now published by the American Hospital Association / American Society of Healthcare Engineering (ASHE).
All interested parties are invited to submit proposed revisions and/or additions to update the existing Guidelines, which are revised every four years to keep pace with new concepts and capabilities in the delivery of health care. The proposal period has already concluded and the Health Guidelines Revision Committee (HGRC) has met to develop a shaded text version of the 2010 edition of the Guidelines. The shaded text version is available to the general public as of September 15, 2008 with an opportunity to provide comments back to the HGRC during the public comment period until December 15, 2008. For the 2010 draft to comment go to http://www.fgiguidelines.org/ to comment. The new edition is anticipated to be available to the public in January of 2010.
Single room study
One issue has been reinforced-- that the Guidelines require single room occupancy as a minimum requirement, versus semi-private rooms.
Single room study files (.doc) (42 KB)
The FGI Research committee commissioned a study and funded the Coalition of Healthcare Environment Research (CHER) to solicit and manage the grant process in order complete such a study in time for use by the HGRC for the 2006 Guidelines review cycle. The study was initiated and completed by November 2003, with results presented to FGI and the full HGRC in time for proposals to be submitted based on the results. Because of the complex nature of the issue, several key issues were addressed:
- First and operating costs;
- Facility management and hospital design;
- Disease control and fall prevention; and
- Therapeutic impacts: Relationship between healing and the environment.
A more detailed background and the complete series of study files are listed below. All materials are available for download and review. The material is being made freely available by FGI in the interests of providing as much information as possible for future design considerations.
Summary of issue: Single versus multiple bed room occupancy
(.doc) (62 KB)
Rationale for private rooms for patient safety explained
Hospitals have moved from large multi-bed wards with as many as 20 patients to semi-private or private rooms for those who could pay. Almost 90 years ago, it was proposed that single-patient rooms were the ideal setting to provide patient care. In the 2006 Guidelines for Design and Construction of Hospitals and Healthcare Facilities (the "Guidelines") used by nearly every state, a requirement for single rooms as a minimum standard was passed by consensus, but applied only in new construction. This standard was based on Single Room study commissioned by the Facilities Guidelines Institute to consider results for the 2006 guidelines, using evidence in the literature that supported this adoption.
A recent JAMA commentary by Detsky et al., noted that most modern hospitals have public value statements regarding safety, dignity, privacy, and patient-centered care. A tangible way to show commitment to these values would be to give patients their own bathroom in a single-patient room and ensure required patient privacy. As the JAMA commentary noted, "it is easier to build a single room once than to teach thousands of individuals to be attentive to patient privacy when patient care is provided in multi-bed rooms." Many reasons in favor of single-patient rooms for reducing infection include that they: reduce nosocomial infection rates, provided that other basic elements of infection control are in place; are easier to clean and decontaminate than multi-bed rooms; induce healthcare professionals to perform hand hygiene when moving between rooms rather than between bed; and obviate the need to move patients because of infection control or end-of-life care.
Although the authors cite the Guidelines single room requirement, they urge clinicians to advocate for single-patient rooms in any new hospital construction, expansion, renovation, or redesign and not wait 50 years for existing hospital structures to deteriorate before the full potential of single-patient rooms can be realized.