Why Shared Hospital Rooms Are Becoming Obsolete

A cushy, new private room at Massachusetts General Hospital

Lower infection rates. More Privacy. Better Sleep.

All in all, happier, healthier patients. That’s why the private, single-occupancy hospital room has become the gold standard in new hospital construction — from Boston to Bolivia — and why having a roommate in the hospital is going the way of the house call.

Health care has changed a lot since the late 1850s, when Florence Nightingale advocated for large, 30-plus patient wards over private rooms. The world’s best-known nurse argued that the spacious, multi-occupancy wards improved the work environment for nurses by making patient supervision easier and therefore, care better.

‘When was the last time you spent the night in a hotel with someone you don’t know?’

In the U.S. these days, with patients rebranded as consumers, expectations have changed. “When was the last time you spent the night in a hotel with someone you don’t know?” is how Jeanette Clough, the CEO of Mt. Auburn Hospital in Cambridge, which is in the midst of converting to an all-private 220-room facility, framed the issue.

The trend toward all-private rooms has been building for some time, says Karen Reno, RN, Ph.D, a managing consultant for Joint Commission Resources, the consulting arm of the Joint Commission, the panel that accredits hospitals. But recently, she’s seen the phenomenon take hold in places as diverse as Vietnam and Bolivia, and across the U.S. in hospitals with money to spend. Though some patients still prefer a roommate — to alleviate loneliness, or for backup help — “the majority of hospitals being built are trying to make private spaces,” Reno says. “There are so just so many compelling reasons to do it.”

1. Contagion

The number one argument for private rooms is infection control.  Around 2 million hospital-acquired infections kill about 100,000 people each year, health officials report. Multiple sick people in a room increase the bad odds. Think about it: a nurse or doctor enters a double-room to check a patient, and before they are able to wash their hands, there’s a moan on the other side of the curtain. The providers rush in to help, and all of the germs they carry come with them. Indeed, single rooms reduce bathroom sharing (enough said), reduce the risk of family members coming into contact with potential infections and make rooms easier to clean and decontaminate.

2. Privacy

Hospital stays generally involve frank discussions about body parts and deeply personal issues, which some people find difficult and stressful. Studies have found some patients actually withhold critical medical information if they think a stranger can hear them. Clough, the Mt. Auburn CEO says: “It becomes noticeably uncomfortable when you talk about a personal issue with just a piece of cloth between you [and your neighbor].” She added that when patients have their own room, they can make middle-of-the-night phone calls or let visitors chatter without worrying about disturbing others.

3. Sleep

It’s not just about the fluffy pillows. Good sleep is critical to healing, and anyone who has spent the night in a hospital knows how elusive it can be. A 2008 white paper by The Center for Health Design and The Georgia Institute of Technology found that “single-bed rooms can reduce noise disturbance from roommates, visitors and healthcare staff and thereby improve patient sleep.” Sleep begets healing which can lead to shorter hospital stays, the thinking goes.

4. Happy Patients, Happy Families

The move toward “patient-centered care” is all about compassion and listening and intuiting everyone’s needs and concerns. Given that hospital stays are by nature unpleasant, what can hospitals do to lighten the mood, and make patients happier?  Surveys show most (though not all) patients prefer single rooms due to the reasons already mentioned, (privacy, sleep, less embarrassment, more opportunity for family members to stay, etc.) according to a 2003 review article by researchers at Simon Fraser University. If you don’t have to share a bathroom with three other patients, things tend to look brighter, and you feel more in control.

But to really enhance the experience, says Jeannette Ives Ericson, Senior Vice President for Patient Care and Chief Nurse at Massachusetts General Hospital, you need a “total healing environment.”

That’s the goal at MGH’s newest facility — the 530,000-square-foot, $687 million Lunder Building, which just got the last of its patients moved in this week. All of the 150 inpatient rooms are private, spacious and cushy, with flat screen TVs and fold-out leather couches for family members. There are tasteful floral curtains and huge windows bursting with natural light. If you squint, the rooms almost seem more boutique hotel than hospital. (Indeed, one of the operations associates who tagged along on my recent tour is a former bartender at the Mandarin Oriental — he’s about to start nursing school. But that’s another story.) The urban garden-themed atrium is landscaped with cascading ivy, a bamboo garden and serene paintings.

With the new building complete, MGH’s 947 rooms are evenly split between private and semi-privates. For a random comparison, the 150-bed Faulkner Hospital in Jamaica Plain has all-private rooms, and Boston Medical Center downtown has 189 single-bed rooms and 109 doubles. (I didn’t poll every hospital in the state; and neither the state nor the national hospital associations keep this kind of data.)

Of course, there’s the cost of building all these private rooms, but some argue those costs are mitigated by savings from factors like decreased infections, fewer medical errors, shorter stays, reduced use of drugs and less staff turnover due to better morale.

The Other Side of The Story

The one thing I keep thinking about, though, is loneliness. The patients without streams of visitors and attentive family members, the ones who might benefit from a kind gesture from a stranger in the next bed.

So, before the double-occupancy hospital room fades into oblivion, I’d like to note a few upsides. Here are three:

1. My Father

Dad’s been in and out of the hospital ever since I can remember: knee operations, tumors removed, bleeding ulcers, debilitating infections, an emergency airlift from Fire Island. In the early 1980s, while he was still teaching philosophy to undergrads, my father spent time in a New York hospital recovering from back surgery. He still remembers his roommate:

“The young man was interested in rock and roll, I think he was a drummer. We talked a lot — he asked me questions as if he thought being older was being wiser. He told me his worries about his surgery, and he wanted to learn more about philosophy. We talked about Sartre, Che Guevera, Marx, Heidegger, and I would try to translate them into ordinary language. He was all fired up, and got someone to buy him “The Birth of Tragedy” (Nietzsche). For me, he was a very good distraction.”

2. My close mom-friend

She found herself in a two-bed room on an obstetric ward when she went into premature labor a full nine weeks before her due date.  She had to remain hospitalized in hopes the pregnancy would last as long as possible. On her first night, still shocked at the sudden turn of events and frightened for her baby, she made the mistake of wishing her late mother were still alive and there to give her comfort, and found herself quietly crying into her pillow. Her roommate, in for a kidney infection, heard the snuffling and offered some comfort. “I cried my first night in here too,” she said. “You have to remember that the chances are overwhelming that everything’s going to be all right.”

And on a more frivolous note…

3. Seinfeld

Without two-in-a-room, one of the most memorable scenes from Seinfeld wouldn’t have been. It’s the one where George goes to visit his mother in the hospital so he can enjoy her voluptuous young roommate getting a sponge bath on the other side of the flimsy curtain.

Readers, please add your hospital room stories here. Did you bond with a roommate, or did a private room vastly improve your medical experience?

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  • saratea2u

    I disagree Nick do you have any idea what the malpractice and HIPPA violations, the American public is much more litigious than in Europe.

  • Jade rosjun

    I had experience few years back when I had a labor at the hospital. After the labor I had been hospitalized for 5 days. That was the worse sleeping time in my life. I was in pain still and sick as well. I had a roommate who had her family member stayed overnight with her who was snoring all night really really loud. Normally, I am really sensitive to noise and always have a hard time sleeping. So, any noise can make me stay up even my entire body needs to rest. When the new family came to share in the room, it didn’t make the situation better. The kept watching tv really bothering me. >>>Please stop sharing a room in the hospital !!

  • Morneau Celeste

    I was a patient at MGH for 4 weeks last September and October in the new Lunder Bldg.  My room looked exactly like the one pictured above.   I loved having a private room and it was very pleasant to have the light and look out at the city lights.  It did get a bit lonely at times but I still preferred it to having a roomate.

  • xray

    On two different occasions, in two different hospitals, I was sharing a surgical recovery hospital room and was able to alert the nursing staff during night about serious adverse events happening to my room mate for which he was unable to call (or realize his situation) and which required immediate attention. In a private room they would probably have suffered, or in the one case bled to death.  

  • ib42

    Overall, I’m for it. It’s mainly the loss of privacy and, frankly, the bodily functions gone awry that often times create..um….odors!
    On the other hand there is the loneliness factor, but it’s the luck of the draw. You might get someone in severe pain who, poor things, moan and groan all night..and call for a nuse every five minutes.
    Yes. solo is better for me.

  • JLP

    I prefer a room to myself just for the quiet, but I once had a roommate who was so needy about everything possible that the nurses tuned her out and ignored when she called for them.  Lucky for her and them, I noticed that she seemed more agitated at one point than before and called them myself to come take a look at her.  Turned out she was having a severe allergic reaction to her pain meds.  A roommate can come in handy!

  • Brennan511

    Juvenile hall is as close to treatment as I’v ever had [except when I was 4 yr old, inhaled nut shell]. A remote/lonely spartan room [needs shower] for medicine… might be so effective one could cure war? [no treat]
    As a youth I had a sure-feel-good-Fantasy that I was in a hospital after some accident [ready to walk?, but after the much deserved sympathy/attention/Escape?]   ; perhaps a “survivor fantacy” surviving foreign-ignorance and undesirables [conditions] alike.
    In the Wild-West you just bite the bullet {John Wayne had his own room}. But in a traditional community privacy is not really an issue. Prevention is; but only when pro-scribed.

  • Dannydee56

    Poor people don’t spend a lot of time at hospitals.  No money, you heal at home!

  • http://pulse.yahoo.com/_UXSCL33HYBE3YDO2B6U4SMSCAU judithg

    make sure you get into a shared room or a ward. it’s the best way to stay alive. if it weren’t for my city hospital ward mate who got up at 3am when i had convulsions, i would have been dead at 19.  shared rooms with at leasst two patients means that nurses and doctors are going in and out of the room all night and that gives you a chance to grab one or point to an infusion that needs refilling.
    the only infections you get are from hospital staff who don’t wash their hands. airborne illnesses don’t make it out of private or seuested rooms, unless yu are in a very strange hospital.

  • ab2cup

    I agree with Nick Knight.  Assuming the principal of supply and demand holds.  If you shrink the number of beds, then the cost of a bed goes up.
     Having the option of a single bed room is OK, but also provide multiple bed rooms too.
    Both of my sons spent a couple of days in the hospital in Germany when they were under 7 years old.  Not only were there other patients in the room, but my wife stayed over night in the room with them.  The kids shared toys and movies.  It was far better for them than being alone.

  • http://twitter.com/BrienneCalmer Brienne Calmer

    Hospitals have to consider what patients want in addition to the medical benefits.  The hospital I work for relies heavily on patient feedback, and patients are consistent in wanting quiet and privacy.  The desire for space of our own is distinctively American, and it’s deeply rooted.  (Remember Daniel Boone’s philosophy about what makes a neighborhood too crowded?)

  • SM in Virginia

    omg….a few years ago I had to spend a week in a hospital after major surgery….started out with a younger roommate….she was on her cell phone constantly, even very late into the evening…I’m talking midnight.  Also, she kept the TV on constantly, even if it was muted, when it was 2 a.m., the flickering/changing lights and colors made it almost impossible for me to sleep.  I even asked one of the nurses to speak to her….he was hesitant to do so.  She finally left after a few days and I got some peace.  Generally, I think single rooms are a good idea.  Privacy is a huge issue.  With all the privacy mandated in HIPAA, then you have some doc come in and start explaining all this stuff to you or your roommate and the other person can hear it all….surely a privacy issue.

  • Alicia from NYC

    Just spent a week in a NYC hospital due to a perforated appendix.  My first roommate was a meth user who got very antsy (and chatty and demanding) by 10am each morning as she bargained with the staff for meds.  Not a great roommate.  I kept out interactions to a minimum.  My second was a nice Dominican lady who loved to watch TV and whose large family congregated in her half of the room early each evening.  We exchanged personal information on a few ocassions but maintained our privacy as much as possible.  No great philosophical exchanges with either, though I felt much more secure with my second lady.  And from my walks on the hall, I saw many worse potential roomies–older patients, many with dementia.

    Should single rooms be the standard?  If economically feasible, sure.  I felt well enough throughout my stay to handle the social aspectis of sharing a room, but it I were dog sick or in-and-out mentally, I would want a higher level of privacy.  It’s bad enough that a constantly changing cast of nurses, technicians, residents and others are in and out constantly, with no prior notice.

  • Nick Knight

    What BS.  I had my first son born in Ireland. After birth we were moved to a room of six.   Europe has a lot more shared rooms, and their health care outcomes are far higher, ohh and the cost was a small fraction of the US birth.   Sounds like more spin, to make the medical industry even wealthier.