Should single rooms be the norm in hospitals?
Multi-patient rooms are the status quo for New Zealand hospitals, with up to five people staying in each room.
New research argues that this breaches safety and ethical concerns, saying that single patient rooms should be the most basic standard of care.
Researcher and author Dr Cindy Towns told Kerre Woodham that while it may seem counterintuitive for single rooms to be as economical as multi-patient rooms, poor care costs money.
She says that having multiple people in one room can create more room for infection to spread, and the inability to manage the environment completely can exacerbate some conditions.
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Speaker 1 (00:06):
You're listening to the Kerrywood of Mornings podcast from News
Talks d B.
Speaker 2 (00:11):
I was interested in a piece in The Conversation yesterday
about the need for single rooms in all public hospitals.
It's currently perfectly normal, as we well know, for those
of us who stayed in hospital to stay in shared
rooms with up to five other people. It used to
be four other women if you were female, for other men,
if you're a bloke. Then all of a sudden, we're
all in together, and you looking at the goujons of
(00:34):
the chap opposite as they clamber into an out of bed.
In some hospitals, despite serious safety and ethical concerns, there
have been real issues raised about shared rooms. New research
argues that it should not be this way, and senior
lecture at University of Otago, doctor Cindy Towns joins me. Now,
(00:56):
thank you for your time, doctor Towns.
Speaker 3 (00:58):
Oh carey, and thanks for having me on Kilder.
Speaker 2 (01:01):
It seems counterintuitive that single rooms can be as economic
is bunking us all in together. How can that be? Sid?
Speaker 3 (01:12):
I think for those of us who work in the hospital,
it's it's pretty obvious, but you're right, it's an argument
that that's often thrown back at us just as a reflex,
but basically, poor care costs money, and certainly coming out
of COVID, I think you don't need a medical degree.
Speaker 1 (01:31):
To know that.
Speaker 3 (01:32):
You know if you have more infection you're going to
have more cost just in bed days alone, even if
you're not interested in saving lives and reducing suffering, if
you're going to if you have multi bedrooms, you need
more hospital trendsfers for when people's clinical situation changes, and
that creates cost and more infection. And one of the
(01:55):
things we've brought to get in this paper with my
geriatrician hat On in general position hat On is delirium
and dementia are actually hugely prevalent and getting much worse,
and we it might sound very basic, but the management
of delirium and dementia requires single rooms. You need to
be able to manage nois and intrusion and interruption, as
(02:16):
straightforward as that sounds, and when you don't do that,
you increase the severity and duration of those conditions in
a game that increases length of stay and increased costs
as well as has an impact on the patients in
terms of morbidity and mortality. So there's actually some quiet
sound economical justifications for single hospital rooms, even if you're
(02:39):
not interested in saving lives and alleviating human suffering, which
I would like our focus to obviously be on. But yeah,
there are some strong economical arguments in favor of single optins, their.
Speaker 2 (02:48):
Design, our hospital staff in favor of it. Is it
easier to look after patients if they're on their own.
Speaker 3 (02:56):
Oh, from a medical perspective, much easier because you can
meet basic e standards of KIRE. So it's actually quite
distressing for we talk about moral stress a lot and
burnout and so it's actually really distressing to not be
able to provide a basic standard of care for our
patients and we can't so medically, Yeah, widespread support or
(03:19):
that from a nurse and perspective, and we talk about
this in the paper. This is a paper in the
ame Z's Journal of Public Health, and we do talk
about some of the nurse and concerns, but there's seen
some really good studies on that, and the and the
stuff around nursing is pretty inconsistent in terms of those concerns.
(03:39):
And it's about really getting used to that single occupancy
design and having some better care around, you know, better mattresses,
better observation abilities, and having the nursing stuff actually get
used to that. So from a medical perspective, absolutely unequivocal,
(04:00):
and from a nurse and perspective, it's just really getting
used for that new design.
Speaker 2 (04:05):
So it comes to how they would be designed. Instead
of a curtain, you'd have a plywood wall, would you.
Speaker 3 (04:13):
As silly as it selfs walls and doors to say
you can't manage somebody's clinical needs without walls and doors,
you can't. And again you don't need a medical degree
to know that. But what's really important also about this
paper is actually when we build multi occupancy rooms, we
built in we build in violations of patients basic rights,
(04:37):
their human rights and their rights as to the it's
a minimal standard of care that the HD and C
Code of Rights as well as the Health Information Privacy Code.
So one of the things that was of concerned to
us as positions and academics are on this paper is
how could we actually continue to build new hospitals that
(04:57):
violates these funds, that are these fundamental standards that it
just renders the Code of Rights to fairy tales and
such water had actually omitted in some of their HD
and C complaints that they can't comply with the coat.
They can't comply with those basic rights within a multi
occupancy room, So it then seems ironic that they continue
(05:18):
to build multi occupancy rooms.
Speaker 2 (05:21):
Yeah, I mean, having been a guest of the Public
Health Service and a very satisfied five star rating, you know,
I don't want to say I'd love to come again,
but find you if I have to. I mean, it's amazing,
absolutely amazing, you know. I I didn't really want to
listen to the lady with the hip operation while I
(05:43):
was waiting for my wrist operation, demanding an enemy. But
even less did I want to hear it being administered
with nothing but a thin curtain between us. It's horrible.
And then i'm you know, and when you're staring up
across the room, straight up the nightgown of the patient
opposite you, you know, they're all sort of out of it.
Speaker 3 (06:03):
I'm sure they've heard of female patients cleaning up the
incontinence of the men waiting for their prostate surgery, So
can you imagine. Yeah, I'm so sorry you went through that,
but that's it's a ubiquitous experience it is, and those
those poor men, yes, for opposite you, it's an absolute
violation of their business and privacy as.
Speaker 2 (06:23):
Well, exactly. So you go out and you whip up
the curtain and you just you just think, I hope
they've got family coming and soon that can rearrange them all.
And the lessings are for amazing too. But it should be.
Speaker 1 (06:33):
Neat to be like that.
Speaker 3 (06:35):
The important thing though, when you're talking about single gender
rooms is that that's actually about policy. So we'll never
get to one hundred percent without better design one hundred
percent single gender rooms, but we can get well over
ninety or ninety five percent. That comes down to bed management.
We've proved in Wellington that we can do that without
(06:56):
delay and care. There's a wonderful charge nurse in Auckland
who's been running single gender policy for ten years and
been reporting on it in the same way they do
in the Nate. Just twenty ten, I've done some work
at a wonderfully understaffed, great little preperal hospital up in
tens and that charged nurse swums to show up there
single gender operation. So this is about an erosion of
(07:18):
basic expandards of here, and we actually had the Prime Minister,
the Minister of Health and the Head of Quality and
Safety last year when we wrote a paper on single
gender rooms saying they were in favor of a single
gender policy. We've proved we can do it without actually
costing anything. So where is it? So that's about our
health leadership because we've done all the work, hundreds and
(07:39):
hundreds of hours of the work. We've done it. It
just needs to be rolled out. So you know, that's
that's poor health leadership. That one that's about policy.
Speaker 2 (07:49):
And how do we fix that that's going to take
more than hundreds of hours of work to try and
health system. So there's all there. That's a blood. You know,
it makes sense that when you read it, Yeah, it
is really that One's that.
Speaker 3 (08:05):
And it's been in the NHD is because of the
risk of sexual assault and I'm so sorry to bring
that up, but because of the risk of sexual assault
onwards with confuse their only patients running around and the
risk of harassment and intrusion. The NHS in the UK
has been running a single gender policy since twenty ten
and they have the same problems with overcrowding and lack
(08:26):
of sends that we do. So that one's about policy
and leadership and dead management. But in terms of hospital design,
for everybody to have signescy and privacy, and combined with
the code, we need single occupancy rooms. So single gender
rooms will mistigate some of those serious risks, but it
(08:48):
won't help with delirium, dementia and infection. Single occupancy design
will cover everything and should reduce cost in the long term,
because hospitals should last for generations. You know, they don't
last for ten minutes. They should last for generations.
Speaker 2 (09:03):
And you to interesting. Just finally, I just wonder too
whether some of these ghastly, vile, racist outbursts from patients
who don't have poor mental, healthy just ugly people. I
wonder if they might be minimized if they haven't got
an audience to play to you.
Speaker 3 (09:24):
Single occup single occupancy rooms work for everyone. Yeah, they
work for They work for our high prevalence conditions. They
are basic clinical guidelines, they work for the Code of Rights.
They reduce safety risks, and they and they mitigate the
sort of harm that unfortunately comes from those sort of
(09:45):
attitudes and behavior that we would never condone in ospitale.
Speaker 2 (09:49):
Thank you so much, really interesting. That was a great
read I really appreciate your time.
Speaker 3 (09:54):
Oh, thank you so much, and thank you for giving
it some mere time. It's something we've ignored, but again,
it really is about common sense that one.
Speaker 2 (10:01):
Yeah, I think so too. Dr Cindy Town, Senior Lecturer,
University of Otago.
Speaker 1 (10:06):
For more from Kerry Wood and Mornings, listen live to
News Talks at B from nine am weekdays, or follow
the podcast on iHeartRadio
You're listening to the Kerrywood of Mornings podcast from News
Talks d B.
Speaker 2 (00:11):
I was interested in a piece in The Conversation yesterday
about the need for single rooms in all public hospitals.
It's currently perfectly normal, as we well know, for those
of us who stayed in hospital to stay in shared
rooms with up to five other people. It used to
be four other women if you were female, for other men,
if you're a bloke. Then all of a sudden, we're
all in together, and you looking at the goujons of
(00:34):
the chap opposite as they clamber into an out of bed.
In some hospitals, despite serious safety and ethical concerns, there
have been real issues raised about shared rooms. New research
argues that it should not be this way, and senior
lecture at University of Otago, doctor Cindy Towns joins me. Now,
(00:56):
thank you for your time, doctor Towns.
Speaker 3 (00:58):
Oh carey, and thanks for having me on Kilder.
Speaker 2 (01:01):
It seems counterintuitive that single rooms can be as economic
is bunking us all in together. How can that be? Sid?
Speaker 3 (01:12):
I think for those of us who work in the hospital,
it's it's pretty obvious, but you're right, it's an argument
that that's often thrown back at us just as a reflex,
but basically, poor care costs money, and certainly coming out
of COVID, I think you don't need a medical degree.
Speaker 1 (01:31):
To know that.
Speaker 3 (01:32):
You know if you have more infection you're going to
have more cost just in bed days alone, even if
you're not interested in saving lives and reducing suffering, if
you're going to if you have multi bedrooms, you need
more hospital trendsfers for when people's clinical situation changes, and
that creates cost and more infection. And one of the
(01:55):
things we've brought to get in this paper with my
geriatrician hat On in general position hat On is delirium
and dementia are actually hugely prevalent and getting much worse,
and we it might sound very basic, but the management
of delirium and dementia requires single rooms. You need to
be able to manage nois and intrusion and interruption, as
(02:16):
straightforward as that sounds, and when you don't do that,
you increase the severity and duration of those conditions in
a game that increases length of stay and increased costs
as well as has an impact on the patients in
terms of morbidity and mortality. So there's actually some quiet
sound economical justifications for single hospital rooms, even if you're
(02:39):
not interested in saving lives and alleviating human suffering, which
I would like our focus to obviously be on. But yeah,
there are some strong economical arguments in favor of single optins, their.
Speaker 2 (02:48):
Design, our hospital staff in favor of it. Is it
easier to look after patients if they're on their own.
Speaker 3 (02:56):
Oh, from a medical perspective, much easier because you can
meet basic e standards of KIRE. So it's actually quite
distressing for we talk about moral stress a lot and
burnout and so it's actually really distressing to not be
able to provide a basic standard of care for our
patients and we can't so medically, Yeah, widespread support or
(03:19):
that from a nurse and perspective, and we talk about
this in the paper. This is a paper in the
ame Z's Journal of Public Health, and we do talk
about some of the nurse and concerns, but there's seen
some really good studies on that, and the and the
stuff around nursing is pretty inconsistent in terms of those concerns.
(03:39):
And it's about really getting used to that single occupancy
design and having some better care around, you know, better mattresses,
better observation abilities, and having the nursing stuff actually get
used to that. So from a medical perspective, absolutely unequivocal,
(04:00):
and from a nurse and perspective, it's just really getting
used for that new design.
Speaker 2 (04:05):
So it comes to how they would be designed. Instead
of a curtain, you'd have a plywood wall, would you.
Speaker 3 (04:13):
As silly as it selfs walls and doors to say
you can't manage somebody's clinical needs without walls and doors,
you can't. And again you don't need a medical degree
to know that. But what's really important also about this
paper is actually when we build multi occupancy rooms, we
built in we build in violations of patients basic rights,
(04:37):
their human rights and their rights as to the it's
a minimal standard of care that the HD and C
Code of Rights as well as the Health Information Privacy Code.
So one of the things that was of concerned to
us as positions and academics are on this paper is
how could we actually continue to build new hospitals that
(04:57):
violates these funds, that are these fundamental standards that it
just renders the Code of Rights to fairy tales and
such water had actually omitted in some of their HD
and C complaints that they can't comply with the coat.
They can't comply with those basic rights within a multi
occupancy room, So it then seems ironic that they continue
(05:18):
to build multi occupancy rooms.
Speaker 2 (05:21):
Yeah, I mean, having been a guest of the Public
Health Service and a very satisfied five star rating, you know,
I don't want to say I'd love to come again,
but find you if I have to. I mean, it's amazing,
absolutely amazing, you know. I I didn't really want to
listen to the lady with the hip operation while I
(05:43):
was waiting for my wrist operation, demanding an enemy. But
even less did I want to hear it being administered
with nothing but a thin curtain between us. It's horrible.
And then i'm you know, and when you're staring up
across the room, straight up the nightgown of the patient
opposite you, you know, they're all sort of out of it.
Speaker 3 (06:03):
I'm sure they've heard of female patients cleaning up the
incontinence of the men waiting for their prostate surgery, So
can you imagine. Yeah, I'm so sorry you went through that,
but that's it's a ubiquitous experience it is, and those
those poor men, yes, for opposite you, it's an absolute
violation of their business and privacy as.
Speaker 2 (06:23):
Well, exactly. So you go out and you whip up
the curtain and you just you just think, I hope
they've got family coming and soon that can rearrange them all.
And the lessings are for amazing too. But it should be.
Speaker 1 (06:33):
Neat to be like that.
Speaker 3 (06:35):
The important thing though, when you're talking about single gender
rooms is that that's actually about policy. So we'll never
get to one hundred percent without better design one hundred
percent single gender rooms, but we can get well over
ninety or ninety five percent. That comes down to bed management.
We've proved in Wellington that we can do that without
(06:56):
delay and care. There's a wonderful charge nurse in Auckland
who's been running single gender policy for ten years and
been reporting on it in the same way they do
in the Nate. Just twenty ten, I've done some work
at a wonderfully understaffed, great little preperal hospital up in
tens and that charged nurse swums to show up there
single gender operation. So this is about an erosion of
(07:18):
basic expandards of here, and we actually had the Prime Minister,
the Minister of Health and the Head of Quality and
Safety last year when we wrote a paper on single
gender rooms saying they were in favor of a single
gender policy. We've proved we can do it without actually
costing anything. So where is it? So that's about our
health leadership because we've done all the work, hundreds and
(07:39):
hundreds of hours of the work. We've done it. It
just needs to be rolled out. So you know, that's
that's poor health leadership. That one that's about policy.
Speaker 2 (07:49):
And how do we fix that that's going to take
more than hundreds of hours of work to try and
health system. So there's all there. That's a blood. You know,
it makes sense that when you read it, Yeah, it
is really that One's that.
Speaker 3 (08:05):
And it's been in the NHD is because of the
risk of sexual assault and I'm so sorry to bring
that up, but because of the risk of sexual assault
onwards with confuse their only patients running around and the
risk of harassment and intrusion. The NHS in the UK
has been running a single gender policy since twenty ten
and they have the same problems with overcrowding and lack
(08:26):
of sends that we do. So that one's about policy
and leadership and dead management. But in terms of hospital design,
for everybody to have signescy and privacy, and combined with
the code, we need single occupancy rooms. So single gender
rooms will mistigate some of those serious risks, but it
(08:48):
won't help with delirium, dementia and infection. Single occupancy design
will cover everything and should reduce cost in the long term,
because hospitals should last for generations. You know, they don't
last for ten minutes. They should last for generations.
Speaker 2 (09:03):
And you to interesting. Just finally, I just wonder too
whether some of these ghastly, vile, racist outbursts from patients
who don't have poor mental, healthy just ugly people. I
wonder if they might be minimized if they haven't got
an audience to play to you.
Speaker 3 (09:24):
Single occup single occupancy rooms work for everyone. Yeah, they
work for They work for our high prevalence conditions. They
are basic clinical guidelines, they work for the Code of Rights.
They reduce safety risks, and they and they mitigate the
sort of harm that unfortunately comes from those sort of
(09:45):
attitudes and behavior that we would never condone in ospitale.
Speaker 2 (09:49):
Thank you so much, really interesting. That was a great
read I really appreciate your time.
Speaker 3 (09:54):
Oh, thank you so much, and thank you for giving
it some mere time. It's something we've ignored, but again,
it really is about common sense that one.
Speaker 2 (10:01):
Yeah, I think so too. Dr Cindy Town, Senior Lecturer,
University of Otago.
Speaker 1 (10:06):
For more from Kerry Wood and Mornings, listen live to
News Talks at B from nine am weekdays, or follow
the podcast on iHeartRadio
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