Published: August 03, 2008 12:55 am         

Focused on privacy

Trend moving away from sharing hospital rooms

FAIRMONT — When patients have been completely moved into 72 private rooms in a newly constructed, 200,000-square-foot tower at Monongalia General Hospital in the next week or so, they will be part of a trend taking place not only in the region but all over the country.

No longer will they have to share a room with a stranger and experience all that can go along with that, from agreeing which program to watch on TV to listening to each other’s guests and private medical history as doctors and nurses ask them questions.

Patients also will have less exposure to each other’s illnesses — including staph infections and pneumonia, two of the more common ailments that can be “hospital-acquired” when they do share a room as well as a toilet, sink and shower.

“We feel in today’s environment, from an infection standpoint, private treatment rooms are the safest way of providing care for patients,” said David J. Robertson, president and CEO of Monongalia General Hospital.

“Second, it’s what I tell everybody. Who would ever go on vacation and ask to be permitted to room with a complete stranger? We would never do that. In hospitals, historically, it’s been done for the convenience of caregivers, but it’s not best for patients.”

Bruce Carter, CEO of Clarksburg’s United Hospital Center, which will be an all-private room facility after a move in 2010 off exit 124 of Interstate 79, made the same analogy.

“If I’m traveling and pull over at night to a motel and the guy who is registering me says, ‘Here you go, you have to sleep in the same room with this guy tonight, we only have semi-private rooms,’ what would your reaction be?” he asked.

“I’ve asked the question, ‘Why does it become OK when you are sick?’ When you are sick, you want more privacy.”

Both hospital administrators listed many reasons why the move toward private rooms benefits not only patients but doctors and nurses as well.

Semi-private rooms “causes a lot of transferring,” Carter said. “You start playing musical beds and transferring people around.”

In addition to putting the same gender of patients together, nurses also have to make sure the illnesses and ages also match up. Often, beds go unused if good matches cannot be found, which means the hospital is not being maximized.

“It can really tie up nursing staff more, and the more you do it, the more likely it is something gets missed,” Carter said. “It can be simple, such as losing a personal item of clothing that’s left back in the room or you can miss a diet order. It’s back-breaking work, and then the patient family shows up and the patient is no longer in the room. So the nurses have to try to get on the phone and find them.”

Right now, the current UHC houses 318 patient rooms, 78 of them single, said hospital public relations director Steve Bovino. The new UHC — a $300 million project — will have about the same number of rooms, but all will be private. Sleeper sofas will allow family members to stay with their loved ones at night, something hospital administrators now not only allow but also encourage.

At Mon General, Robertson expects work to begin soon on a complete renovation of the older portion of the hospital for a complete $92 million project that should be complete in October 2009. Then, the hospital will have 189 all-private rooms, up from the current 165 beds with two-thirds of them in semi-private rooms.

Other design elements also will give patients more privacy, such as separate corridors for the public to walk through and for the patients to be transported through to various procedures.

“When I say we are focused on privacy, it’s not just in terms of patient rooms,” Robertson said. “Literally everything about this project is about privacy. Every registration space is in a private office. No information will be given at a counter.”

Privacy has become a big factor at hospitals with the passage of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), which, among other things, legislates that all health information remain confidential between a patient and caregivers.

“If there are two patients in a room, there is hardly any way you can guarantee patient privacy,” said Rick Wade, senior vice president for the American Hospital Association in Washington, D.C. “Once, I was in a room with an elderly relative, and I asked her, ‘What did the doctor say?’ And the lady in the next bed said, ‘He said she’d be in here a couple more days and then she could go home.’

“HIPAA laws almost make private rooms a necessity if you want to guarantee patient privacy.”

Although plans for the Mon General addition and the new UHC both were well in the works before 2006, that’s the year the American Institute of Architects changed hospital guidelines that called for private rooms as the minimum standard for new construction or major remodeling. A subsidiary of the AIA, the Facility Guidelines Institute, drafted the guidelines that about 40 states follow when constructing new hospitals or remodeling older ones.

“The West Virginia State Hospital Licensure Rule requires adherence to these guidelines,” said Anita Barnhouse, D.O., a program manager with the state Office of Health Facility Licensure and Certification, who noted that the rule went into effect on May 1, 2006. “Hospitals must follow the state licensure rule in order to be in compliance with the Medicare regulations. They must follow the Medicare regulations in order to receive Medicare reimbursement.”

Guidelines, which can be viewed on the AIA Web site, www.aia.org, only apply to those states that adhere to the AIA standards, said Scott Miller, past president of the Academy of Architects for Health, and Joseph Sprague, senior vice president for HKS Architects in Dallas, a leading designer of hospitals in the country.

“A couple of states — including Texas, California and Illinois — have their own health-care standards and they do not accept the AIA guidelines as the minimum design for a variety of reasons,” Miller said.

Industry leaders meet to draft new guidelines every five years. Private patient rooms were considered in 2001, Sprague said, but the idea was tabled then. Two primary reasons for tabling the issue included fear of rising health-care costs and fewer infection control problems back in 2001.

“At the time, we weren’t experiencing the infection control problem that we were in 2006,” Sprague said.

When the group reconvened in 2006, however, they were armed with statistics from the National Institutes of Health in Bethesda, Md., stating that 90,000 patients were dying each year from hospital-acquired infections.

“The problem was getting out of hand and something needed to be done,” Sprague said.

As for rising health-care costs, in West Virginia, those are regulated by the West Virginia Health Care Authority, noted Robertson, who does not believe Mon General’s new addition will prompt a significant rise in charges.

“I’m not going to say it will have no impact on health care,” he said. “Last year, the authority approved us to have about a 4 percent greater increase than we normally would have been granted without the project, but that was last year. The year we’re in, we’ve been granted the standard raise. It has had a very marginal impact on our charges.”

Plus, as Sprague pointed out, hospital-acquired infections also impose costs on the health-care system.

“We had a discussion about the trade-offs, and we discovered if you reduce one infection, you’ve saved the hospital $50,000,” he said.

However, Albert Pilkington, CEO of Fairmont General Hospital, said that while hospital administrators have been interested in building a new patient tower in the next five or 10 years that would expand the number of private rooms available, he fears that a universal health-care program passed in the next few years could undermine those plans.

“We want to wait to see what goes on on a national level,” he said. “We want to be good stewards of the community hospital. The worst thing would be to spend $70 million on a patient tower only to have the amount of services paid to hospitals be cut in half and put the hospital at risk.”

The hospital has about 25 private patient rooms, Pilkington said, which represents about one-quarter of the available, in-patient beds. Although the hospital has a total of 206 beds, that count includes psychiatric beds, the intensive-care unit, the maternity ward and other areas of the hospital that would not be open to general-admission patients.

At WVU Hospitals, said spokeswoman Amy Johns, the majority of the patient rooms in the 20-year-old hospital already are private. Twenty-two rooms — or 44 beds — are semi-private out of the hospital’s 450 total beds, she said. That count includes WVU Children’s Hospital.

The need for privacy and infection control has dovetailed during a time when a lot of new hospitals are being built, noted the AHA’s Wade.

“While we don’t have any numbers, it’s a very steady movement” toward private hospital rooms, Wade said. “We’re in probably the biggest period of hospital construction since World War II.”

Following World War II, the Hill-Burton Act of 1946 was designed to provide low-cost loans to improve the hospital system in the United States.

“That caused a lot of hospitals to be built in the 1950s, and they’ve been added on to and they are at the end of their useful life,” Wade said. “They just can’t be used anymore. The way we deliver patient care has changed. The technology has changed and the ways those hospitals were constructed just aren’t serviceable. They’re either being gutted and changed completely or new hospitals are being built to replace them.”

Often, equipment and machines can be taken to a room so procedures can be performed there instead of moving the patient.

“It provides patients and people taking care of them more flexibility,” Wade said.

That flexibility will be appreciated at both Mon General and UHC, by both the staff and patients, administrators said.

“We’re looking forward to private rooms,” said UHC’s Carter. “Like most hospitals, we only have a small number of them on each unit, and there is a lot of pressure all the time from folks to be placed there. It’s very hard on the nursing staff and patients.”

E-mail Mary Wade Burnside at mwburnside@timeswv.com.

     

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