110 * THE ACUTELY UNWELL PATIENT AND SINGLE ROOMS

Abstract

Introduction: There is concern that benefits of single-rooms such as privacy and independence may be outweighed by clinical need for observation. Studies supporting their safety were conducted in non-NHS, high intensity areas e.g. ITU, with high nurse-patient ratios. There are no studies in general medical or geriatric populations. One study showed those in single-rooms had observations recorded less frequently.Half the beds in all newly built NHS hospitals must be single-rooms. In 2011, our hospital moved from nightingale wards to a new building with 100% single-rooms providing the opportunity to evaluate the implications of single-rooms on patient safety.Patient at Risk (PAR) Score is a validated and widely used tool to detect clinical deterioration. To determine whether single-rooms might impede early recognition of unwell patients, we examine PAR scores in both shared accommodation and single-rooms pre- and post-move.Method: Pre-existing surveillance data for inpatients over 16 years old on medical wards were examined. This included critical care outreach (CCO) records for all reviews for high PAR score or clinical concern for one-year, and data on peri-arrest and arrest calls over 9 months, both pre- and post-move.Mean PAR scores were examined using the unpaired t-test and linear regression for age-adjusted analysis.Results: The proportion of peri-arrests to arrests did not change (p = 0.64) indicating that those scoring highly were not under-represented in CCO data.Shared AccommodationSingle-RoomDifference Mean (95% CI)P-valueUnadjusted5.0 (3.0)5.1 (2.4)0.1 (−0.4, 0.7)0.63Age adjusted (Mean (SD))0.3 (−0.2, 0.9)0.25Age– Median (IQR) (Mann-Whitney)75 (64, 83)69 (61, 77)0.005Conclusion: Findings do not support the notion that patients in single rooms are not monitored effectively such that clinical deterioration goes un-noticed. Increased numbers of nurses per shift may be contributory in a protective fashion.