'The perfect' patient does not exist
December 13, 2013
Of the small number of hospitals that, in the middle of the crisis, are still being built, a large number are opting for the design of the single patient room. Is this not a remarkable choice in a time of austerity?
Evidence for and against a single room
There is support for and opposition to the single room concept. Both sides present their own evidence and associated quality reasoning. These range from 'before and after studies' to 'expert opinions'. Supporters advocate for the single room because it limits (cross) infection. They point out the reduction in errors related to medication. The patient also has more privacy, which results in better quality of sleep for the patient, the family is always welcome and it offers a more agreeable setting for conduction a confidential discussion with doctors and nurses. In the longer term, a single room offers more value, is more cost efficient and most probably results in a lower mortality rate!
Opposers point out the higher costs a single room involves. Higher construction costs as well as higher nursing costs. Furthermore the patient misses out on social contact and control. Above all, opposers argue that supporters of single rooms do not have any hard evidence to support their arguments.
This discussion can go on forever.
What does it actually boil down to? It involves the patient and patient-centered care, which goes hand in hand with family-centered care. We can place the patient at the center of the matter based on what we know at the moment. What we know is who the future patients will be (everyone). And we can learn more about their opinions through a population study. We also know that the average patient is becoming older, increasingly has comorbidity and can pick up infections that are more difficult to fight and which therefore must be prevented.
We can combine these figures related to patient needs with facts about single rooms to which we already have access. There are currently several hospitals in the Netherlands that have fully opted for the single bed system. I am curious about their figures compared with other hospitals. They must provide some extremely interesting information. Construction costs versus hospital costs such as (cross) infection, patient satisfaction in diverse areas, average bed occupancy and mortality rates. Naturally, many outcomes are 'multifactorial' but it is still a step towards optimal care.
Everyone makes the decision to opt for a single room based on his or her own perspective. There is a lack of research. Research into the patient's perspective, that of the care provider and of the financier. It is the only way for us to conclude whether the single room system indeed offers the advantages that we ascribe to it. Until then, as a hospital director with plans for a new construction, I would invest my money in early warning techniques for patient safety. Involve the family more in the patient's care process and strive for a more flexible single occupancy construction. You could always take down a wall...
This article was also published on Skipr.nl.