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Private hospital rooms may be both cost-effective and a way to improve care

This article first appeared in the St. Louis Beacon, May 27, 2011 - While her husband rested in his room at SSM St. Clare Health Center, Lois Simpson walked down the hall to a quiet lounge of floor-to-ceiling windows, lots of natural light and a view of an equally tranquil wooded area just beyond the building.

"This is such a gorgeous place," said Simpson, who will have been married to her husband, Ray, for 65 years in October. "It's relaxing just to look out the window. I leave the room at times just to come out here to enjoy the scenery."

It's probably unusual to hear people talk about a hospital's ambience, but St. Clare in Fenton is not your usual hospital. The primary difference is that patients there are cared for in relatively large private rooms, called suites. Each has a sitting area and a pullout sofa bed to accommodate a family member who, like Simpson, might want to spend the night with the patient.

Area architects says private-rooms only facilities will eventually become the norm as hospitals renovate or build new facilities. They say the shift stems from several factors, perhaps the most important one being a recommendation by a panel of architects, doctors, and hospital administrators that private rooms become the standard for new hospitals. Other factors driving the shift include efforts to reduce hospital-borne infections that are said to be less likely to occur in private rooms; efforts to score high on a government-developed patient satisfaction rating system; and, to a lesser degree, a push to stay competitive with other hospitals to attract patients.

Several area hospitals aside from St. Clare have embraced the private-rooms model. About five years ago, SSM Cardinal Glennon Children's Medical Center replaced its 44-bed open ward intensive care unit with 60 private patient rooms. Both St. Anthony's Medical Center and St. John's Mercy Medical also have built wings with private rooms only. But St. Clare is the only St. Louis County facility with only private rooms. It opened two years ago as a 154-bed replacement for SSM St. Joseph Hospital of Kirkwood. St. Clare has since added 20 additional beds.

Reducing Infection Rates

The shift toward private rooms has been influenced in part by studies showing lower hospital-acquired infection rates among patients in private rooms, says Dr. Tim Pratt, St. Clare's chief medical officer. He points to one Canadian study showing a 47 percent decrease in certain hospital-triggered infections among ICU patients in private rooms. Most studies come from Canada and European nations that offer universal health care, he says.

"They have your life history, from birth to death, so you get a lot of data on trends and longevity. It's hard to get that information in this country," Pratt said.

While the shift to a private rooms adds expenses, Pratt says a recent Canadian study showed that private rooms were cost effective.

"In Canada and European countries that have total control of their health-care dollars, you'll find there is a cost benefit that covers the whole milieu of healing," he said. The Canadian study "brought in a lot of factors, such as getting people in and out of the hospital half a day quicker. They found it more expensive to build the rooms but less expensive in the long term."

Pratt also says it's no more expensive to get care at St. Clare than at facilities offering semi-private rooms.

"I like to think of it as a hotel. You're in a $500 room, but you pay $110 for it. You can charge whatever you want, but the reimbursement is pretty well set. So we don't get extra reimbursement because we are a private room platform."

Privacy Matters

Mary Brobst, executive director of nursing at St. Clare, says other factors also make private rooms more desirable, including family and patient satisfaction. That's an issue mentioned by St. Clare patient Phyllis L. Heinz, 87.

"When you're in a two-bed room, you may have a nice companion. That's fine, but sometimes it isn't fine. Plus, if a family member wants to stay with me, there's room for them."

Another issue is privacy itself. Brobst says some patients feel less comfortable speaking freely with health-care providers in a semi-private room shared with strangers.

"If I'm going to give you my personal health information, I may not want a stranger in the room," Brobst said. "In that case, I might not tell you everything."

She also says that having a family member stay in the room with the patient offers an advantage because the relative can let the caregiver learn things about the patient that a doctor or nurse might miss.

"We may be meeting the patient for the first time, but a family member would know if something is not right," Brobst said.

Pratt adds that some older people might feel more comfortable if a family member is there. A relative's presence "decreases stress for the person who is ill," he said.

Another issue that sets St. Clare apart is the absence of central nursing stations. Instead, nurses sit in pods next to the entrance to each room. The arrangement keeps the nurse closer to the patient. The pod has a computer and a window facing the patient's room.

The window has a blind that the nurse can open to monitor patients without startling them or waking them if they are asleep, Brobst says. A computer inside the patient's room gives doctors the option of viewing patient data in the pod before making rounds or calling up the data and discussing the information with patients while in the room.

Most hospitals have a central area for all patient medications. At St. Clare, however, medications are stored in a drawer in a patient's room. It's protected by a computer-controlled lock. The hospital says medical errors are prevented because the medication includes a bar code that must match information on a patient's armband.

Making A Patient Feel At Home

The idea behind St. Clare is to not only to offer private rooms but to make patients forget they are in a hospital, says spokeswoman Debbie Parker.

"The wood paneling behind the bed helps to conceal medical equipment. We try to give patients a feeling of being at home as much as they can. There's a safe, a refrigerator and a sound machine to provide soothing white noise. And we don't have visiting hours. So people are welcome 24/7."

Most states have adopted an American Institute of Architects' recommendation that private rooms become the standard for new hospitals. The recommendations were developed in 2006 by an AIA panel of hospital administrators, doctors, architects, engineers and infection control experts. Missouri has yet to adopt the recommendations, but many hospitals in the area are following them, says Robert Winters, principal in OWH Inc., a Clayton-based architecture and planning firm that does a lot of work for the hospital industry. He points to private-rooms only renovations at St. Anthony's and St. John's as examples of where the trend is headed. He says consumers will see more private rooms only facilities whenever local hospitals build from the ground or renovate.

Dave Dillon, vice president media relations, Missouri Hospital Association, concedes that the shift also is influenced to some degree by a combination of competition and the tendency of keeping up with the Joneses.

"If you can offer a private room rather than a semiprivate room, certainly a consumer may be more interested in choosing your facility," he says. " If you can offer it and your competition doesn't, well clearly that is a decision point. It probably wouldn't be the only one, but it certainly is more attractive for a patient."

But Dillon says other much bigger issues are driving the trend. One he points to is the new federal rating system that allows consumers to compare hospitals. The rating system is called the Hospital Consumer Assessment of Healthcare Providers and Systems -- HCAHPS (pronounced "H-caps") for short. The system allows consumers to use the internet to compare hospitals in categories ranging from cleanliness to quietness.

Good scores on H-caps "is clearly a priority for hospitals," Dillon said. "It involves things like was it quiet in the area where you were getting care. If there are two people in a room, you're going to have more interruptions from hospital staff, more visitors."

The H-caps survey, released in April, shows that patients liked a lot of things about St. Clare, ranked among the three top area hospitals in patient satisfaction. The other two were Barnes-Jewish West County Hospital and St. Luke's Hospital. Patients rated St. Clare highest for quiet at night and for cleanliness. The hospital also tied with Barnes-Jewish West for overall patient satisfaction and for the tendency of hospital staffers to take the time to explain medicines before administering them.

However, St. Luke's rated highest on the question of whether patients would recommend the hospital to friends and family. On that question, 84 percent of patients at St. Luke's said they would, followed by 81 percent of patients at St. Clare and 79 percent at Barnes-Jewish West.

Federal health officials began implementing the rating system about two years ago. They describe the survey as an objective way to gauge patient satisfaction. They also says the survey seeks to boost transparency and accountability among hospitals and encourages them to improve quality of care.

Funding for the Beacon's health reporting is provided in part by the Missouri Foundation for Health, a philanthropic organization that aims to improve the health of the people in the communities it serves.

Robert Joiner has carved a niche in providing informed reporting about a range of medical issues. He won a Dennis A. Hunt Journalism Award for the Beacon’s "Worlds Apart" series on health-care disparities. His journalism experience includes working at the St. Louis American and the St. Louis Post-Dispatch, where he was a beat reporter, wire editor, editorial writer, columnist, and member of the Washington bureau.