Health Care and Insurance and Environment and Government

Shared patient rooms in hospitals soon to be history: Guidelines call for private quarters in all new facilities

April 10, 2006

New guidelines due out in June will call for newly constructed hospitals to come equipped with all private patient rooms, the first time such a minimum requirement has been issued.

The guidelines, published every four years by the Facilities Guidelines Institute and the American Institute of Architects' Academy of Health, are used by nearly 40 state governments-including Indiana-to set regulations, approve construction plans and license hospitals to operate.

And hospitals nationwide-including those in Indiana-are expected to embrace the guidelines that are said to foster care that cuts down on the spread of infections, lessens the incidence of medical errors and addresses privacy issues that crop up in shared rooms.

In fact, hospitals in Indiana and elsewhere have been going all private for some time.

"I said in the recent past, 'We'll never build another semi-private room acute care hospital again,'" said Mark Hayden, project manager of Community Hospital North's expansion project. "Customers demand a private room, so for new or existing facilities, the move is to private care."

Nearly 70 percent of Community North's rooms are already private, and the rest will be converted to private over the next few years, Hayden said.

Community Hospital East is going all private as well. The Indiana Heart Hospital at Community North-which opened three years ago-was built with all private rooms.

"We want to create a really patientfocused, exceptional experience for the people who come here for care," said Barb Summers, CEO of Community North.

Patients want their families with them, and private rooms can accommodate them better, Summers said.

A private room allows conversations between doctor and patient to be just that-private. Families can be brought in at the onset so when they take the patient home, they're more able to continue the care.

"A long time ago, people just didn't take as active a role in their medical care as they do today," Summers said. "They entrusted everything to their doctor."

In addition to responding to a more engaged patient population, hospitals see going all private as a way to cut down on the spread of infectious disease and thus speed up recovery.

The authors of the soon-to-be-released guidelines studied the effect on patients' health and recovery in private versus semiprivate rooms.

In addition to the risk of infection from a patient in the next bed, semi-private room occupants are often moved to other rooms for compatibility reasons, the report said. The transfers create additional risk of exposure.

Some of the reasons for healthier living in private rooms are obvious. Patients don't share a bathroom where germs thrive, and airborne infections are less likely.

Also, health care professionals are less likely to prescribe medication or procedures for the wrong patient if there is only one in the room.

Patients in private rooms are more likely to have family members or others around who can help them get around more easily, reducing the number of patient falls, which can add thousands of dollars to the hospital bill.

The report also cites less risk of germs being carried from a hospital worker who has just touched one patient, piece of equipment or privacy curtain before touching a roommate without washing his hands in between.

But not everyone thinks the passing of germs by staffers is greatly reduced by keeping patients in separate rooms.

Only about 40 percent of caregivers wash their hands before they touch their next patient, regardless of how those patients are housed, said Mike Brendel, director of operations at the St. Francis Heart Center.

"And that's a national statistic," Brendel said. "So the impact of having a private room really plays only a small factor in that regard."

He did say the more individualized care a private occupant receives creates a stronger connection between doctor and patient, which hastens recovery.

And the design of private rooms these days makes them feel more like hotel suites than hospital rooms, adding to a positive mental attitude.

Internet access, desks, phones and separate family space are becoming the norm.

"Anytime you can make the stay more pleasant and improve their attitude, you will likely hasten recovery," said Roger Barksdale, vice president of St. Francis Hospital and Health Centers.

While about 65 percent of the rooms at St. Francis in Beech Grove are private, its new heart center in Indianapolis built last year is all private. All new construction by St. Francis has private patient rooms.

And that doesn't necessarily mean higher costs for patients.

Historically, hospitals have charged more for a private room, but that price gap between private and semi-private has been narrowing, said David Handel, director of health programs at the School of Public and Environmental Affairs at IUPUI.

Insurance carriers once based the amount they would cover on the semi-private room rate. These days, most insurers pay on a per diem basis, said Handel, former chief operating officer of Clarian Health Partners.

While going all private means fewer beds per square foot and higher construction costs, it doesn't mean less revenue for hospitals.

The average hospital is getting smaller in size anyway because more procedures are done on an outpatient basis, said Toby Orme, director of engineering and construction for St. Francis Hospital and Health Centers.

But in-patient stays are getting shorter, so the beds are turned over more often. And because rooms are private, more are capable of being used at any one time because hospitals don't have to worry about ensuring roommates are of the same sex, religion or other criteria.

So fewer beds are offset by higher occupancy.

And higher construction costs are offset by cost efficiencies in managing private rooms related to fewer patient transfers, higher occupancy and less staff, said Vince Caponi, CEO of St. Vincent Health.

Like other hospitals in the area, St. Vincent is moving to all private rooms. St. Vincent Hospital on 86th Street will be converted over the next few years. Its Carmel facility was built 20 years ago with all private rooms, and St. Vincent's Women's Hospital is 100-percent private.

In fact, all new St. Vincent construction, including the St. Elizabeth Ann Seton Hospital-a long-term acute care facility set to break ground this spring across from the Women's Hospital-will be all private.

Hospital administrators know patients are taking a more active role in their health care and have an even greater choice these days of where to go for care. They want them to be comfortable.

"We all want them to come to our hospital," Caponi said.
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