1
|
Rose DE, Farmer MM, Oishi SM, Klap RS, Bean-Mayberry BA, Canelo I, Washington DL, Yano EM. Does a Welcoming Environment Influence Women Veterans' Primary Care Experiences? Womens Health Issues 2024; 34:540-548. [PMID: 39198050 DOI: 10.1016/j.whi.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 07/05/2024] [Accepted: 07/18/2024] [Indexed: 09/01/2024]
Abstract
BACKGROUND A welcoming environment may influence patient care experiences, and it may be particularly relevant for underrepresented groups, such as women veterans at Veterans Health Administration (VA) facilities where they represent only 8-10% of patients. Challenges to ensuring a welcoming environment for women veterans may include unwelcome comments from male veterans and staff or volunteers and feeling unsafe inside or outside VA facilities. We assessed associations between reports of gender-related environment of care problems and patient-reported outcomes. PROCEDURES We merged national patient-reported outcomes from women veterans (n = 4,961) using Consumer Assessment of Health Plans & Systems Patient Centered Medical Home (CAHPS-PCMH) survey composite measures with Women Veteran Program Managers' reports of gender-related environment of care problems (n = 127, 2016-2017) at VA facilities. We performed multilevel bivariate logistic regressions to assess associations between Women Veteran Program Managers' reports of large/extreme problems and likelihood of women veterans' optimal ratings of primary care experiences (access, coordination, comprehensiveness, provider communication, and overall rating of primary care provider). We adjusted for patient-, site-, and area-level characteristics, and clustering of patients within VA facilities, and we applied design weights to address nonresponse bias in the patient data. Response rates were 40% for women veterans and 90% for Women Veteran Program Managers. MAIN FINDINGS Few (<15%) Women Veteran Program Managers reported large/extreme environment of care problems. Women veterans obtaining care at those sites were less likely to rate provider communication and comprehensiveness (psychosocial health assessed) as optimal. PRINCIPAL CONCLUSIONS Ensuring a welcoming environment may improve women veterans' primary care experiences.
Collapse
Affiliation(s)
- Danielle E Rose
- VA HSR Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California.
| | - Melissa M Farmer
- VA HSR Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Sabine M Oishi
- VA HSR Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Ruth S Klap
- VA HSR Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Bevanne A Bean-Mayberry
- VA HSR Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California; Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California; UCLA Fielding School of Public Health, Los Angeles, California
| | - Ismelda Canelo
- VA HSR Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Donna L Washington
- VA HSR Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Elizabeth M Yano
- VA HSR Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
| |
Collapse
|
2
|
Jo HJ, Choe PG, Kim JS, Lee M, Lee M, Bae J, Lee CM, Kang CK, Park WB, Kim NJ. Risk of nosocomial coronavirus disease 2019: comparison between single- and multiple-occupancy rooms. Antimicrob Resist Infect Control 2024; 13:95. [PMID: 39215349 PMCID: PMC11365205 DOI: 10.1186/s13756-024-01454-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Accepted: 08/22/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND There is an ongoing controversy regarding whether single-occupancy rooms are superior to multiple-occupancy rooms in terms of infection prevention. We investigated whether treatment in a multiple-occupancy room is associated with an increased incidence of nosocomial coronavirus disease 2019 (COVID-19) compared with treatment in a single-occupancy room. METHODS In this retrospective cohort study, every hospitalization period of adult patients aged ≥ 18 years at a tertiary hospital in Korea from January 1, 2022, to December 31, 2022, was analyzed. If COVID-19 was diagnosed more than 5 days after hospitalization, the case was classified as nosocomial. We estimated the association between the number of patients per room and the risk of nosocomial COVID-19 using a Cox proportional hazards regression model. RESULTS In total, 25,143 hospitalizations per room type were analyzed. The incidence rate of nosocomial COVID-19 increased according to the number of patients per room; it ranged from 3.05 to 38.64 cases per 10,000 patient-days between single- and 6-bed rooms, respectively. Additionally, the hazard ratios of nosocomial COVID-19 showed an increasing trend according to the number of patients per room, ranging from 0.14 (95% confidence interval 0.001-1.03) to 2.66 (95% confidence interval 1.60-4.85) between single- and 6-bed rooms, respectively. CONCLUSIONS We demonstrated that the incidence of nosocomial COVID-19 increased according to the number of patients per room. To reduce nosocomial infections by respiratory viruses, the use of multiple-occupancy rooms should be minimized.
Collapse
Affiliation(s)
- Hyeon Jae Jo
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro Jongno-gu, Seoul, 03080, Republic of Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro Jongno-gu, Seoul, 03080, Republic of Korea
- Infection Control Office, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ji Seon Kim
- Infection Control Office, Seoul National University Hospital, Seoul, Republic of Korea
| | - Mimi Lee
- Infection Control Office, Seoul National University Hospital, Seoul, Republic of Korea
| | - Minkyeong Lee
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro Jongno-gu, Seoul, 03080, Republic of Korea
| | - Jiyeon Bae
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro Jongno-gu, Seoul, 03080, Republic of Korea
| | - Chan Mi Lee
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro Jongno-gu, Seoul, 03080, Republic of Korea
| | - Chang Kyung Kang
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro Jongno-gu, Seoul, 03080, Republic of Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro Jongno-gu, Seoul, 03080, Republic of Korea
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro Jongno-gu, Seoul, 03080, Republic of Korea.
- Infection Control Office, Seoul National University Hospital, Seoul, Republic of Korea.
| |
Collapse
|
3
|
Ataiyero Y, Stimpson E, Hall H, Ashby H, Dube A, Carter V, Smith HA, Ross A, Copping J, Morris P, Jones S. Evaluating the impact of a ward environment with 20 single occupancy rooms and two four-bedded bays on patient and staff experiences and outcomes in an acute NHS Trust: a mixed-methods study protocol. BMJ Open 2024; 14:e085528. [PMID: 39107022 PMCID: PMC11308872 DOI: 10.1136/bmjopen-2024-085528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 06/28/2024] [Indexed: 08/09/2024] Open
Abstract
INTRODUCTION Traditionally, wards in acute care hospitals consist predominately of multioccupancy bays with some single rooms. There is an increasing global trend towards a higher proportion of single rooms in hospitals, with the UK National Health Service (NHS) advocating for single-room provision in all new hospital builds. There is limited evidence on the impact of a ward environment incorporating mostly single and some multioccupancy bays on patient care and organisational outcomes. METHODS AND ANALYSES This study will assess the impact of a newly designed 28-bedded ward environment, with 20 single rooms and two four-bedded bays, on patient and staff experiences and outcomes in an acute NHS Trust in East England. The study is divided into two work packages (WP)-WP1 is a quantitative data extraction of routinely collected patient and staff data while WP2 is a mixed-methods process evaluation consisting of one-to-one, in-depth, semistructured interviews with staff, qualitative observations of work processes on the ward and a quantitative data evaluation of routinely collected process evaluation data from patients and staff. ETHICS AND DISSEMINATION Ethical approval was obtained from the UK Health Research Authority (IRAS ID: 334395). Study findings will be shared with key stakeholders, published in peer-reviewed high-impact journals and presented at relevant conferences.
Collapse
Affiliation(s)
- Yetunde Ataiyero
- Centre for Health Innovation, School of Health, Education, Policing and Sciences, Staffordshire University, Stafford, UK
| | - Emma Stimpson
- James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, UK
| | - Helen Hall
- James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, UK
| | - Helen Ashby
- James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, UK
| | - Alisen Dube
- Centre for Health Innovation, School of Health, Education, Policing and Sciences, Staffordshire University, Stafford, UK
| | - Vanda Carter
- Centre for Health Innovation, School of Health, Education, Policing and Sciences, Staffordshire University, Stafford, UK
| | - Hazel A Smith
- Centre for Health Innovation, School of Health, Education, Policing and Sciences, Staffordshire University, Stafford, UK
| | - Al Ross
- Centre for Health Innovation, School of Health, Education, Policing and Sciences, Staffordshire University, Stafford, UK
| | - Jacky Copping
- James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, UK
| | - Paul Morris
- James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, UK
| | - Sarahjane Jones
- Centre for Health Innovation, School of Health, Education, Policing and Sciences, Staffordshire University, Stafford, UK
| |
Collapse
|
4
|
Søndergaard SF, Andersen AB, Kolbaek R, Beedholm K, Frederiksen K. Influence of single-room accommodation on nursing care: A realistic evaluation. Nurs Inq 2023; 30:e12585. [PMID: 37461268 DOI: 10.1111/nin.12585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 07/06/2023] [Accepted: 07/09/2023] [Indexed: 10/24/2023]
Abstract
Nowadays, it is common that newly built hospitals are designed with single-room accommodation, unlike in the past, where shared accommodation was the favoured standard. Despite this change in hospital design, very little is known about how single-room accommodation affects nurses' work environment and nursing care. This study evaluates how the single-room design affects nurses and nursing care in the single-room hospital design. Nurses working in the single-room design predominantly work alone with little opportunity for peer training, interaction and reflection. In addition, the single-room design affects the nurses' work environment due to changes in sensory stimulation and increased walking distances. Furthermore, a change in the discourse, namely, regarding the single room as the patient's home, makes the nurses react to queries, demands and tasks in a new way. Overall, the new hospital design forces the nurses into a more reactive role and affect their way of providing nursing care. Despite this, the nurses find single-room accommodation beneficial for the patients and their nursing care.
Collapse
Affiliation(s)
- Susanne Friis Søndergaard
- Centre for Research in Clinical Nursing, Regional Hospital Central Jutland and VIA University College, Viborg, Denmark
| | - Anne Bendix Andersen
- School of Nursing and Research Centre for Health and Welfare Technology, VIA University College, Viborg, Denmark
| | - Raymond Kolbaek
- Centre for Research in Clinical Nursing, Regional Hospital Central Jutland and VIA University College, Viborg, Denmark
| | - Kirsten Beedholm
- Institute for Public Health, Section for Nursing and Health Care, Aarhus University, Aarhus, Denmark
| | - Kirsten Frederiksen
- Institute for Public Health, Section for Nursing and Health Care, Aarhus University, Aarhus, Denmark
| |
Collapse
|
5
|
Søndergaard SF, Rasmussen B, Kerr D, Frederiksen K, Redley B, Trueman M, Kolbaek R, Laursen HS, Bloomer MJ. Nurses' work experiences in hospital wards with single rooms: An integrative review. J Clin Nurs 2023; 32:7036-7049. [PMID: 37462296 DOI: 10.1111/jocn.16824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 06/03/2023] [Accepted: 07/04/2023] [Indexed: 09/21/2023]
Abstract
AIM AND OBJECTIVE To evaluate evidence that examined nurses' work experiences in hospital wards with single rooms. The research question was 'What does the research tell us about nurses' work experiences in hospital wards with single rooms?' BACKGROUND In the last decades, new hospital builds have moved towards including a high proportion of single rooms. Yet, single rooms create 'complex environments' that impact the nurses. DESIGN A structured integrative review was undertaken of empirical evidence. METHODS Original, peer-reviewed articles, written in English, were sourced from four databases: CINAHL, PubMed, Embase and Web of Science. The initial searches were performed in April 2021 and repeated in December 2022. Quality appraisal was undertaken using the Mixed Methods Appraisal Tool. A narrative synthesis approach was used to analyse the data. Reporting was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. RESULTS Twelve studies, published between 2006 and 2022, with an international origin, and representing n = 826 nurses, were included in this review. The synthesis revealed mixed perspectives about nurses' work experiences in wards with single rooms. Whilst single rooms are 'all good in theory (and) a good idea', the reality was quite different. Synthesised findings are presented in four categories: (i) aesthetics and the physical space, (ii) privacy vs. isolation, (iii) safety, which includes situational awareness and (iv) communication and collaboration. CONCLUSION This review describes how single rooms affects nurses' work experience. Whilst nurses shared multiple concerns about single rooms and the challenges they also acknowledged patient preference for the privacy and space afforded by single rooms. RELEVANCE TO CLINICAL PRACTICE Findings from this review highlight the need for careful planning to maintain and strengthen teamwork, prevent nurses' sense of working in isolation, as well as creating opportunities for mentorship, and collaboration among nurses when working in single-room settings.
Collapse
Affiliation(s)
- Susanne Friis Søndergaard
- Centre for Research in Clinical Nursing, Regional Hospital Central Jutland, Viborg, Denmark
- VIA University College, Nurse Education Viborg, Aarhus University, Health, Aarhus, Denmark
| | - Bodil Rasmussen
- Department of Nursing, Western Health Partnership, Deakin University, Geelong, Victoria, Australia
- Institute for Healthcare Transformation, Centre for Quality and Patient Safety, School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Debra Kerr
- Institute for Healthcare Transformation, Centre for Quality and Patient Safety, School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia
| | | | - Bernice Redley
- Institute for Healthcare Transformation, Centre for Quality and Patient Safety, School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia
| | - Melody Trueman
- Department of Nursing and Midwifery, Western Health, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- Nursing Services, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Raymond Kolbaek
- Centre for Research in Clinical Nursing, Regional Hospital Central Jutland, Viborg, Denmark
- VIA University College, Nurse Education Viborg, Aarhus University, Health, Aarhus, Denmark
| | | | - Melissa J Bloomer
- Department of Critical Care and Nursing, School of Nursing and Midwifery, Menzies Health Institute, Griffith University, Nathan, Queensland, Australia
- Intensive Care Unit, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| |
Collapse
|
6
|
Blane B, Coll F, Raven K, Allen O, Kappeler ARM, Pai S, Floto RA, Peacock SJ, Gouliouris T. Impact of a new hospital with close to 100% single-occupancy rooms on environmental contamination and incidence of vancomycin-resistant Enterococcus faecium colonization or infection: a genomic surveillance study. J Hosp Infect 2023; 139:192-200. [PMID: 37451408 DOI: 10.1016/j.jhin.2023.06.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Vancomycin-resistant Enterococcus faecium (VRE) is a leading cause of nosocomial infection, driven by its ability to spread between patients and persist in the hospital environment. AIM To investigate the impact of a long-established cardiothoracic hospital moving to new premises with close to 100% single-occupancy rooms on the rates of environmental contamination and infection or colonization by VRE. METHODS Prospective environmental surveillance for VRE was conducted at five time-points between April and November 2019, once in the original building, and four times in the new building. Incidence rate ratios (IRRs) of VRE infection/colonization were determined for the one-year period before and after the hospital move, and compared to a nearby hospital. FINDINGS In the original location, the first environmental screen found 29% VRE positivity. The following four screens in the new location showed a significant reduction in positivity (1-6%; P<0.0001). The VRE infection/colonization rates were halved in the new location (IRR: 0.56; 95% confidence interval: 0.38-0.84), compared to the original location, contrasting with an increase in a nearby hospital (1.62; 1.17-2.27) over the same time-period. Genomic analysis of the environmental isolates was consistent with reduced transmission in the new hospital. CONCLUSION The use of single-occupancy rooms was associated with reduced environmental contamination with VRE, and lower transmission and isolation of VRE from clinical samples. The cost-effectiveness of single-occupancy room hospitals in reducing healthcare-associated infections should be reassessed in the context of operational costs of emerging pandemic and increasing antimicrobial resistance threats.
Collapse
Affiliation(s)
- B Blane
- Department of Medicine, Addenbrooke's Hospital, Cambridge, UK.
| | - F Coll
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - K Raven
- Department of Medicine, Addenbrooke's Hospital, Cambridge, UK
| | - O Allen
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - A R M Kappeler
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - S Pai
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - R A Floto
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK; Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK
| | - S J Peacock
- Department of Medicine, Addenbrooke's Hospital, Cambridge, UK; Cambridge University Hospitals NHS Foundation Trust, UK
| | - T Gouliouris
- Department of Medicine, Addenbrooke's Hospital, Cambridge, UK; Cambridge University Hospitals NHS Foundation Trust, UK
| |
Collapse
|
7
|
Bertuzzi A, Martin A, Clarke N, Springate C, Ashton R, Smith W, Orlowski A, McPherson D. 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 systematic review and narrative synthesis. BMJ Open 2023; 13:e068932. [PMID: 37147093 PMCID: PMC10163491 DOI: 10.1136/bmjopen-2022-068932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2023] Open
Abstract
OBJECTIVES Assess the impact of single rooms versus multioccupancy accommodation on inpatient healthcare outcomes and processes. DESIGN Systematic review and narrative synthesis. DATA SOURCES Medline, Embase, Google Scholar and the National Institute for Health and Care Excellence website up to 17 February 2022. ELIGIBILITY CRITERIA Eligible papers assessed the effect on inpatients staying in hospital of being assigned to a either a single room or shared accommodation, except where that assignment was for a direct clinical reason like preventing infection spread. DATA EXTRACTION AND SYNTHESIS Data were extracted and synthesised narratively, according to the methods of Campbell et al. RESULTS: Of 4861 citations initially identified, 145 were judged to be relevant to this review. Five main method types were reported. 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. No clearly consistent conclusions could be drawn about overall benefits of single rooms. 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, some groups were more likely to prefer shared accommodation to avoid loneliness. Greater costs associated with building single rooms were small and likely to be recouped over time by other efficiencies. CONCLUSIONS The 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. PROSPERO REGISTRATION NUMBER CRD42022311689.
Collapse
Affiliation(s)
| | | | | | | | - Rachel Ashton
- Ashton Editorial Consulting, London, UK
- The Health Economics Unit, NHS England and NHS Improvement Midlands, West Bromwich, UK
| | - Wayne Smith
- The Health Economics Unit, NHS England and NHS Improvement Midlands, West Bromwich, UK
| | - Andi Orlowski
- The Health Economics Unit, NHS England and NHS Improvement Midlands, West Bromwich, UK
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | | |
Collapse
|
8
|
Cusack L, Munt R, Verdonk N, Schultz T, Maben J. Comparison of experiences of nursing staff and patients before and after move to 100% single-bed room hospital in Australia: mixed methods. BMC Health Serv Res 2023; 23:81. [PMID: 36698126 PMCID: PMC9875193 DOI: 10.1186/s12913-023-09073-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 01/16/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND There is sufficient and consistent international evidence of issues reported by nurses working in single-bed room environments, requiring a design that is not only comfortable for patients but meets nurses working needs. This paper presents a comparison of nursing staff and patients experience prior to a move to 100% single-bed room hospital in 2016 (Stage 1) and actual experiences after the move in 2021 (Stage 2) in South Australia. METHOD Mixed method case study design. Survey sample of forty-two nursing staff; twelve patient interviews of their experiences of current environment and; thirteen nursing staff interviews of their experiences delivering nursing care in 100% single bed-room environment. RESULTS Nurses and patients highlighted single-bed rooms contributed to patients' privacy, confidentiality, dignity and comfort. As anticipated in Stage 1, nurses in Stage 2 reported lack of patient and staff visibility. This impacted workload, workflow and concern for patient safety. CONCLUSION Patient and nursing staff experiences are interdependent, and implications of single-bed room accommodation are complicated. Future impacts on the health system will continue to affect hospital design, which must consider nurses working needs and patient safety and comfort.
Collapse
Affiliation(s)
- Lynette Cusack
- grid.1010.00000 0004 1936 7304Adelaide Nursing School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia Australia
| | - Rebecca Munt
- grid.1010.00000 0004 1936 7304Adelaide Nursing School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia Australia
| | - Naomi Verdonk
- grid.1010.00000 0004 1936 7304Adelaide Nursing School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia Australia
| | - Tim Schultz
- grid.1014.40000 0004 0367 2697Flinders University, Adelaide, South Australia Australia
| | - Jill Maben
- grid.5475.30000 0004 0407 4824University of Surrey, Guildford, UK
| |
Collapse
|
9
|
Karvonen S, Holma T, Korpelainen J, Leivonen K, Michelsson K, Rantala MR, Porkkala T, Lukkarila P. Key Flow Processes on Wards. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2022; 16:208-222. [PMID: 36325801 DOI: 10.1177/19375867221134550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: The aim of the study is to test a new nurse movement route analysis (NMRA) method for measuring nurses’ traffic volume between rooms on wards. Background: The World Health Organization calls for urgent investment in nurses. On the other hand, the challenges in the availability, direct care activity, and staffing of registered nurses make increasing the quality of care by process improvement a central objective for nursing. Method: The method is based on cellular operations with from/to matrix that describes nurse movements between rooms on a ward. The NMRA can be implemented by traditional manual observation or with a novel internet-of-things solution named SKAnalysis. Results: The greatest nurse flows led to patient rooms, nurses’ stations, and medicine rooms. The manual NMRA recorded a total of 3,040 room visits by nurses; visits to patient rooms accounted for 33% of all room visits, while visits to nurses’ stations accounted for 28%, and visits to the medicine room for 10%. The internet-of-things NMRA recorded a total of 25,841 room visits by nurses; patient room visits accounted for about 43% of all room visits, while nurses’ station visits accounted for 26% and medicine room visits for about 8%. Based on the results, researchers present the development examples and priorities for nursing. Conclusions: NMRA works and is a new universal method for analyzing nurses’ traffic which is a basic premise for improving working methods and productivity on the wards. Internet-of-things solution makes the implementation of NMRA six times more efficient than by the manual NMRA.
Collapse
Affiliation(s)
| | - Tuomas Holma
- Northern Ostrobothnia Hospital District, Oulu University Hospital, Finland
| | - Juha Korpelainen
- Northern Ostrobothnia Hospital District, Oulu University Hospital, Finland
| | - Kirsi Leivonen
- Siun sote – Joint municipal authority for North Karelia social and health services, Finland
| | | | | | - Timo Porkkala
- Heart Hospital, Tampere University Hospital, Finland
| | - Pirjo Lukkarila
- Northern Ostrobothnia Hospital District, Oulu University Hospital, Finland
| |
Collapse
|
10
|
Karvonen S, Eskola M, Haukilahti A, Porkkala T. Patient-Flow Analysis for Planning a Focused Hospital Layout: Tampere Heart Hospital Case. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2022; 15:264-276. [PMID: 35341358 DOI: 10.1177/19375867221086199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The objective of this study is present how a patient movement-based patient-flow analysis is performed for planning the new Heart Hospital of Tampere University Hospital and how patient transfer distances can be shortened by this method. BACKGROUND The Heart Hospital had served patients as a service line organization for years. However, the Heart Hospital layout rather looked like functional layout instead of service line layout because the units of the Heart Hospital have been spread out around the large university hospital campus. METHOD The flow routes of patients treated over the course of 1 year were analyzed by information technology systems in the hospital planning phase. Then, the proximity ranking of the main functions of the Heart Hospital was made. Layout planning was performed based on the proximity ranking. Nine months after the opening of the new Heart Hospital, the distances between the various hospital functions were calculated for the old Heart Hospital and the new one. RESULTS In the old Heart Hospital, patients' transfer distance was 5,654 km (3,513 miles), while the corresponding figure for the new Heart Hospital was 3,797 km (2,359 miles), which means the distance was reduced by 33%. CONCLUSION The patient-flow analysis works as it generated substantially shorter patient transfer distances in the new Heart Hospital. Shorter distances have supported more fluent patient flows that, in turn, has contributed higher productivity and quality of care.
Collapse
Affiliation(s)
| | - Markku Eskola
- Heart Hospital, Tampere University Hospital, Finland.,Faculty of Medicine and Health Technology, Tampere University, Finland
| | | | - Timo Porkkala
- Heart Hospital, Tampere University Hospital, Finland
| |
Collapse
|
11
|
Søndergaard SF, Beedholm K, Kolbæk R, Frederiksen K. Patients' and Nurses' Experiences of All Single-Room Hospital Accommodation: A Scoping Review. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2021; 15:292-314. [PMID: 34636692 DOI: 10.1177/19375867211047548] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM AND OBJECTIVE To identify, examine, and map literature on the experiences of single-room hospital accommodation, exploring what is known about how single-room accommodation in hospitals is viewed by patients and nurses. BACKGROUND Worldwide, hospital design is changing to mainly single-room accommodation. However, there is little literature exploring patients' and nurses' experiences of single-room designs. DESIGN Scoping review following the Joanna Briggs Institute guidance on scoping reviews. METHODS We conducted the search in medical databases for scientific and gray literature. The four authors independently used a data extraction tool to include sources from the searches. The sources were discussed during the process, and in case of a disagreement between two reviewers, the third and fourth reviewer would be invited to participate in the discussion until consensus was achieved. RESULTS We included 22 sources published during the period 2002-2020, with a majority (n = 16) during the period 2013-2020. The sources were distributed on 10 different countries; however, England dominated with 14 publications. We found three main maps for reporting on patients' experiences: (1) personal control, (2) dignity, and (3) by myself. For the nurses' experiences, we found four main maps: (1) the working environment, (2) changes of nursing practice, (3) privacy and dignity, and (4) patient safety. CONCLUSION We suggested that patients' and nurses' experiences are predominantly interdependent and that the implications of single-room accommodation is a large and complex issue which goes beyond hospital design.
Collapse
Affiliation(s)
- Susanne Friis Søndergaard
- Centre for Research in Clinical Nursing, Regional Hospital Viborg, VIA University College, Aarhus University, Denmark
| | | | - Raymond Kolbæk
- Centre for Research in Clinical Nursing, Regional Hospital Viborg, VIA University College, Aarhus University, Denmark.,Deakin University, Burwood, Victoria, Australia
| | | |
Collapse
|
12
|
Patient Room Design: A Qualitative Evaluation of Attributes Impacting Health Care Professionals. Crit Care Nurs Q 2021; 44:334-356. [PMID: 34010208 DOI: 10.1097/cnq.0000000000000369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The focus of this research was to identify what attributes of patient room designs are most beneficial to health care professionals and to explore whether particular professionals hold certain beliefs about patient room attributes. Acute care, progressive care, and intensive care patient room designs were analyzed through the use of pre- and postoccupancy evaluations of a cardiovascular service line. Fourteen focus groups and 1 interview among 74 health care professionals were conducted. Qualitative analysis of the data was guided by a multidimensional framework. A descriptive quantitative assessment was additionally made to reveal positive, negative, or neutral trends and determine the frequency of attributes discussed. The findings revealed outcomes in 4 primary areas: (1) clearance around the bed; (2) visibility; (3) access to the bathroom/bathroom configuration; and (4) access to daylight/views of the exterior. This study identified 8 additional categories. Outcomes illustrate perceptions from a myriad of health care professionals, but the nurses, therapists, and interdisciplinary members of the care team station offered the greatest depth of information. As patient room designs continue to evolve, building on evidence gathered as new or established models are evaluated will become increasingly important.
Collapse
|
13
|
Lemaire JJ, Chaix R, Sontheimer A, Coste J, Cousseau MA, Dubois C, San Juan M, Massa C, Raynaud S, Usclade A, Pontier B, El Ouadih Y, Abdelouahab K, Maggiani L, Berry F. Risk-Taking Behaviors of Adult Bedridden Patients in Neurosurgery: What Could/Should We Do? Front Med (Lausanne) 2021; 8:676538. [PMID: 34447760 PMCID: PMC8382714 DOI: 10.3389/fmed.2021.676538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/08/2021] [Indexed: 11/13/2022] Open
Abstract
Risk-taking behaviors of adult bedridden patients in neurosurgery are frequent, however little analyzed. We aimed to estimate from the literature and our clinical experience the incidence of the different clinical pictures. Risk-taking behaviors seem to be more frequent than reported. They are often minor, but they can lead to death, irrespective of the prescription of physical or chemical constraints. We also aimed to contextualize the risks, and to describe the means reducing the consequences for the patients. Two main conditions were identified, the loss of awareness of risk-taking behaviors by the patient, and uncontrolled body motions. Besides, current experience feedback analyses and new non-exclusive technological solutions could limit the complications, while improving prevention with wearable systems, neighborhood sensors, or room monitoring and service robots. Further research is mandatory to develop efficient and reliable systems avoiding complications and saving lives. Ethical and legal issues must also be accounted for, notably concerning the privacy of patients and caregivers.
Collapse
Affiliation(s)
- Jean-Jacques Lemaire
- Institut Pascal, Université Clermont Auvergne, CNRS, INP Clermont-Auvergne, Clermont-Ferrand, France.,Service de neurochirurgie, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Rémi Chaix
- Institut Pascal, Université Clermont Auvergne, CNRS, INP Clermont-Auvergne, Clermont-Ferrand, France.,Service de neurochirurgie, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Anna Sontheimer
- Institut Pascal, Université Clermont Auvergne, CNRS, INP Clermont-Auvergne, Clermont-Ferrand, France.,Service de neurochirurgie, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Jérôme Coste
- Institut Pascal, Université Clermont Auvergne, CNRS, INP Clermont-Auvergne, Clermont-Ferrand, France.,Service de neurochirurgie, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Marie-Anne Cousseau
- Direction de la Recherche et de l'innovation, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Charlène Dubois
- Service de neurochirurgie, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Mélanie San Juan
- Service de neurochirurgie, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Christelle Massa
- Service de neurochirurgie, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Sandrine Raynaud
- Service de neurochirurgie, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Alexandra Usclade
- Direction de la Recherche et de l'innovation, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Bénédicte Pontier
- Institut Pascal, Université Clermont Auvergne, CNRS, INP Clermont-Auvergne, Clermont-Ferrand, France.,Service de neurochirurgie, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Youssef El Ouadih
- Institut Pascal, Université Clermont Auvergne, CNRS, INP Clermont-Auvergne, Clermont-Ferrand, France.,Service de neurochirurgie, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | | | | | - François Berry
- Institut Pascal, Université Clermont Auvergne, CNRS, INP Clermont-Auvergne, Clermont-Ferrand, France
| |
Collapse
|
14
|
Pati D, Valipoor S, Lorusso L, Mihandoust S, Jamshidi S, Rane A, Kazem-Zadeh M. The Impact of the Built Environment on Patient Falls in Hospital Rooms: An Integrative Review. J Patient Saf 2021; 17:273-281. [PMID: 31157738 DOI: 10.1097/pts.0000000000000613] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aims of this study were to identify and evaluate scientific evidence examining the impact of the built environment on patient falls in hospital rooms. METHODS An integrative review (IR) with a systematic literature search was performed using the patient, intervention, comparison, outcome framework. We searched CINAHL, PsychINFO, PubMED, and Web of Science databases. The search included peer-reviewed studies from 1990 to 2017 written in English. An additional hand search was also conducted. Selected articles were reviewed and rated based on a hierarchical categorization, comprising six evidence levels, developed by the American Association of Critical-Care Nurses and adapted for evidence-based design systematic literature reviews. RESULTS After a multitiered process, 30 articles met the selection criteria. Thematic areas were created based on the examined elements of the physical environment including patient room configuration and available space, bathroom configuration, bathtub and shower, door, bed height and bed rail, flooring, floor mats, patient chair, lighting, toilet, handrail, grab bars, intravenous pole, sink, ceiling lift, and wheelchair and walking aids. Findings of studies on each element are discussed in detail. CONCLUSIONS Some environmental elements have not been examined in past relational or causal studies, and the level of evidence for the examined attributes is not high enough to gain robust confidence in healthcare design decision-making. Because of the low level of evidence for several environmental elements, conclusions must be taken with caution. More studies using quantitative, relational, or causal designs are recommended to develop actionable interventions on patient falls in hospital rooms.
Collapse
Affiliation(s)
- Debajyoti Pati
- From the Department of Design, College of Human Sciences, Texas Tech University, Lubbock, Texas
| | - Shabboo Valipoor
- Department of Interior Design, College of Design, Construction and Planning, University of Florida
| | - Lesa Lorusso
- Department of Interior Design, College of Design, Construction and Planning, University of Florida
| | - Sahar Mihandoust
- From the Department of Design, College of Human Sciences, Texas Tech University, Lubbock, Texas
| | - Saman Jamshidi
- From the Department of Design, College of Human Sciences, Texas Tech University, Lubbock, Texas
| | - Apoorva Rane
- From the Department of Design, College of Human Sciences, Texas Tech University, Lubbock, Texas
| | - Mahshad Kazem-Zadeh
- Rinker School of Construction Management, College of Design, Construction and Planning, University of Florida, Gainesville, Florida
| |
Collapse
|
15
|
Gregersen M, Mellemkjær A, Foss CH, Blandfort S. Use of single-bed rooms may decrease the incidence of hospital-acquired infections in geriatric patients: A retrospective cohort study in Central Denmark region. J Health Serv Res Policy 2021; 26:282-288. [PMID: 33586483 DOI: 10.1177/1355819621994866] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Patients accommodated in single-bed rooms may have a reduced risk of hospital-acquired infections (HAIs) compared to those in multi-bed rooms. This study aimed to examine the effect of single-bed accommodation on HAIs in older patients admitted to a geriatric ward. METHODS A retrospective cohort study of patients admitted to geriatric wards in a university hospital in Central Denmark Region linked to a move to a newly built hospital, involving all consecutively admitted patients aged 65 years and over from 15 September to 19 December 2016 and a similar cohort admitted in the same three months in 2017. We compared the incidence of HAIs in patients in single-bed accommodation to those in multi-bed accommodation using retrospective review of electronic patient records, with all infections verified microbiologically or by X-ray with onset between 48 hours after admission to 48 hours after discharge from hospital. RESULTS In total 446 patients were included. The incidence of HAIs in multi-bed accommodation was 30% compared to 20% in single-bed accommodation. The hazard ratio was 0.62 (95% Confidence Interval 0.43-0.91, p = 0.01) for single-bed accommodation. This finding remained robust after adjustment for age, sex, infection at admission, risk of sepsis, use of catheter, treatment with prednisone or methotrexate, and comorbidity index. CONCLUSION Accommodation in single-bed rooms appeared to reduce HAIs compared to multi-bed rooms in two geriatric wards. This finding should be considered as hypothesis-generating and be examined further using an experimental design.
Collapse
Affiliation(s)
- Merete Gregersen
- Clinical Nurse Specialist, Associate Professor, Department of Geriatrics, Aarhus University Hospital, Denmark
| | - Anders Mellemkjær
- Physician, Department of Geriatrics, Aarhus University Hospital, Denmark
| | - Catherine H Foss
- Physician, Department of Geriatrics, Aarhus University Hospital, Denmark
| | - Sif Blandfort
- Registered Nurse, Department of Geriatrics, Aarhus University Hospital, Denmark
| |
Collapse
|
16
|
Rich RK, Jimenez FE, Puumala SE, DePaola S, Harper K, Roy L, Brittin J. From Fable to Reality at Parkland Hospital: The Impact of Evidence-Based Design Strategies on Patient Safety, Healing, and Satisfaction in an Adult Inpatient Environment. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2020; 14:65-82. [PMID: 33176490 DOI: 10.1177/1937586720970198] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This research aimed to evaluate the quantitative effects of new hospital design on adult inpatient outcomes. BACKGROUND Tenets of evidence-based healthcare design, notably single-patient acuity-adaptable and same-handed rooms, decentralized nursing stations, onstage offstage layout, and access to nature were expected to promote patient healing and increase patient satisfaction, while decreasing adverse events. METHODS Patient healing was operationalized through length of stay (LOS) and patient safety through three adverse events: falls, hospital-acquired infections (HAI), and medication-related events. Standard patient surveys captured patient satisfaction. Patient records from 2013 through 2017 allowed for equivalent time periods surrounding the move to the new hospital in August 2015. Stratified by hospital division where significant, pre/post comparisons utilized proportional hazards or logistic regression models as appropriate; interrupted time series analyses afforded longitudinal interpretations. RESULTS Observed higher postmove LOS was due to previously increasing trends, not increases after the move. In surgical and trauma units, a constant increase in falls was unaffected by the move. Medication events decreased consistently over time; medication events with harm dropped significantly after the move. No change in HAI was found. Significant improvement on most relevant patient satisfaction items occurred after the move. Call button response decreased immediately after the move but subsequently improved. CONCLUSION Results did not clearly indicate a net change in adult inpatient outcomes of healing and safety due to the hospital design. There was evidence that the new hospital improved patient satisfaction outcomes related to the environment, including comfort, noise, temperature, and aesthetics.
Collapse
Affiliation(s)
| | | | - Susan E Puumala
- School of Health Sciences, University of South Dakota, Vermillion, SD, USA
| | - Sheila DePaola
- 21114Parkland Health and Hospital System, Dallas, TX, USA
| | - Kathy Harper
- Formerly of Parkland Health and Hospital System, Dallas, TX, USA
| | - Lonnie Roy
- 21114Parkland Health and Hospital System, Dallas, TX, USA
| | | |
Collapse
|
17
|
Greer V, Johnson E, Hsu J. Variables and Outcomes in Patient Room Design: A Study of Design Hypotheses. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2020; 14:219-233. [PMID: 32929997 DOI: 10.1177/1937586720954952] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Research was conducted to evaluate the correlation between design hypotheses and performance outcomes in single-occupancy patient rooms. BACKGROUND Health environments host complex interactions between patients and clinicians, and patient rooms offer a unique lens to understanding the impact of design on interactions and outcomes. This places importance on articulating, measuring, and assessing design hypotheses. This study of documented strategies and measured outcomes in patient room design investigates the relationship between design variables and clinical interactions. METHODS Design hypotheses were identified for the strategic approach to four key elements of patient room design: the room configuration, charting location, personal protective equipment (PPE) supply, and mobile supply cart. Researchers collected observational data from existing and newly constructed patient rooms in order to evaluate performance outcomes related to design hypotheses. RESULTS Observation data supported hypotheses behind three of the four design components and revealed greater insight into how design variables impacted interactions in patient rooms. CONCLUSIONS The study identified a distinction between "fixed" design elements, such as the configuration of the patient room, and "dynamic" elements such as the design of the mobile cart. This was more prevalent in evaluating the use of supply carts and PPE cabinets, which may be more influenced by training, while the room configuration and charting location require little training to benefit both clinicians and patients. This study points to the value of research that evaluates correlations between design hypotheses and outcomes in healthcare design.
Collapse
Affiliation(s)
- Valerie Greer
- School of Architecture, 14434The University of Utah, Salt Lake City, UT, USA
| | | | - Josephine Hsu
- Sam Fox School of Design and Visual Arts, 7548Washington University in St. Louis, MO, USA
| |
Collapse
|
18
|
McDonald EG, Dendukuri N, Frenette C, Lee TC. Time-Series Analysis of Health Care-Associated Infections in a New Hospital With All Private Rooms. JAMA Intern Med 2019; 179:1501-1506. [PMID: 31424489 PMCID: PMC6705142 DOI: 10.1001/jamainternmed.2019.2798] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
IMPORTANCE Health care-associated infections are often caused by multidrug-resistant organisms and substantially factor into hospital costs and avoidable iatrogenic harm. Although it is recommended that new facilities be built with single-room, low-acuity beds, this process is costly and evidence of reductions in health care-associated infections is weak. OBJECTIVE To examine whether single-patient rooms are associated with decreased rates of common multidrug-resistant organism transmissions and health care-associated infections. DESIGN, SETTING, AND PARTICIPANTS A time-series analysis comparing institution-level rates of new multidrug-resistant organism colonization and health care-associated infections before (January 1, 2013-March 31, 2015) and after (April 1, 2015-March 31, 2018) the move to the hospital with 100% single-patient rooms. In the largest hospital move in Canadian history, inpatients in an older, tertiary care, 417-bed hospital in Montréal, Canada, that consisted of mainly mixed 3- and 4-person ward-type rooms were moved to a new 350-bed facility with all private rooms. EXPOSURES A synchronized move of all patients on April 26, 2015, to a new hospital with 100% single-patient rooms equipped with individual toilets and showers and easy access to sinks for hand washing. MAIN OUTCOMES AND MEASURES Rates of nosocomial vancomycin-resistant Enterococcus (VRE) and methicillin-resistant Staphylococcus aureus (MRSA) colonization, VRE and MRSA infection, and Clostridioides difficile (formerly known as Clostridium difficile) infection (CDI) per 10 000 patient-days. RESULTS Compared with the 27 months before, during the 36 months after the hospital move, an immediate and sustained reduction in nosocomial VRE colonization (from 766 to 209 colonizations; incidence rate ratio [IRR], 0.25; 95% CI, 0.19-0.34) and MRSA colonization (from 129 to 112 colonizations; IRR, 0.57; 95% CI, 0.33-0.96) was noted, as well as VRE infection (from 55 to 14 infections; IRR, 0.30, 95% CI, 0.12-0.75). Rates of CDI (from 236 to 223 infections; IRR, 0.95; 95% CI, 0.51-1.76) and MRSA infection (from 27 to 37 infections; IRR, 0.89, 95% CI, 0.34-2.29) did not decrease. CONCLUSION AND RELEVANCE The move to a new hospital with exclusively single-patient rooms appeared to be associated with a sustained decrease in the rates of new MRSA and VRE colonization and VRE infection; however, the move was not associated with a reduction in CDI or MRSA infection. These findings may have important implications for the role of hospital construction in facilitating infection control.
Collapse
Affiliation(s)
- Emily G McDonald
- Clinical Practice Assessment Unit, Department of Medicine, McGill University Health Centre, Montréal, Québec, Canada.,Division of Infectious Diseases, Department of Medicine, McGill University, Montréal, Québec, Canada.,McGill Interdisciplinary Initiative in Infection and Immunity, Montréal, Québec, Canada
| | - Nandini Dendukuri
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Charles Frenette
- Division of Infectious Diseases, Department of Medicine, McGill University, Montréal, Québec, Canada.,McGill Interdisciplinary Initiative in Infection and Immunity, Montréal, Québec, Canada
| | - Todd C Lee
- Clinical Practice Assessment Unit, Department of Medicine, McGill University Health Centre, Montréal, Québec, Canada.,Division of Infectious Diseases, Department of Medicine, McGill University, Montréal, Québec, Canada.,McGill Interdisciplinary Initiative in Infection and Immunity, Montréal, Québec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| |
Collapse
|
19
|
Healthcare Providers' Perceptions of Single-Room Versus Traditional Maternity Models: A Concurrent Mixed-Methods Study. J Perinat Neonatal Nurs 2019; 33:312-321. [PMID: 31135698 DOI: 10.1097/jpn.0000000000000413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
While many hospitals have transitioned from traditional maternity care to a single-room maternity model, little is known about how healthcare providers' practice differs between the models. This mixed-methods study compared healthcare providers' job satisfaction and team collaboration between traditional and single-room maternity care and explored how each model shaped providers' practice. Data were collected via questionnaires and interviews with healthcare providers from 2 hospitals. Independent t tests, Mann-Whitney U tests, and thematic analysis were used in analysis; findings were then triangulated. No difference was found in team collaboration and job satisfaction scores between single-room (n = 84) and traditional (n = 42) maternity care; however, providers described different means toward satisfaction and collaboration in the interviews (n = 18). Single-room maternity care providers valued interprofessional teamwork, patient/family involvement, and continuity of care. Traditional maternity care providers enjoyed specialization but described teamwork as uniprofessional and disconnected across professions; transfers between units weakened communication and fragmented care. While single-room maternity care providers described less tension and a more holistic patient-family journey, further research must be undertaken to examine whether and how interprofessional collaboration and communication impact patient and health system outcomes.
Collapse
|
20
|
Taylor E. Letter to the Editors. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2018; 11:82-84. [DOI: 10.1177/1937586717747410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|