Patient Satisfaction

Patient satisfaction is critically important to the health care industry today due to the competitive nature of the field. Patients have many choices when it comes to seeking medical attention, and hospitals are dependent on return business to stay operational. Hospitals have traditionally utilized the semi-private room model in order to increase profitability. A semi-private room is a room shared by two patients. Each patient is given their own bed, but they usually share a single bathroom. Unfortunately the financial practice of using semi-private rooms comes at the expense of patient satisfaction.

Research has shown that private rooms increase patient satisfaction, because of the decreased likelihood of nosocomial infection, a quieter environment, and the inherent privacy afforded when conducting patient care. Nosocomial Infection Perhaps the biggest challenge facing healthcare today is the epidemic of hospital acquired (nosocomial) infection. Patients come to the hospital for varying degrees of injury, or illness with the expectation of receiving medical treatment. What they are not expecting is exposure to potentially life threatening infections during their stay.

According to a joint study by Jimma University and Addis Ababa University the most common causative agent found in nosocomial infection is Staphylococcus aureus. This harmful pathogen can be transmitted via direct or indirect contact. This means the pathogen can be transmitted by patient to patient contact, staff to patient contact, or the sharing of a common surface like a toilet seat (Bereket et al. , 2012). Patients in private rooms are far less likely to come into contact with each other, shared surfaces, or shared medical equipment all of which can harbor infectious microorganisms (Skocynska et al. , 2012).

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Standardizing the practice of private rooms can greatly reduce nosocomial infection rates within patient populations. Patient's who contract nosocomial infection are bound to have lower satisfaction rates. By reducing the nosocomial infection rate hospitals can ensure increased patient satisfaction. To make matters worse strains of methicillin-resistant S. aureus (MRSA) are becoming commonplace. MRSA is easily transmittable and resistant to most commonly used antimicrobial agents (Bereket et al. , 2012). Nosocomial infections such as MRSA result in increased length of stay, higher morbidity rates, and increased cost of hospitalization.

Recent studies have shown that each exposure to a new roommate in the hospital setting results in a 10% increase in the risk of acquiring MRSA (Stall, 2012). Private rooms eliminate the possibility of exposure to MRSA infection related to roommates in the hospital setting, which vastly reduces the rate of hospital acquired MRSA infections amongst all patient populations. Reducing the spread of MRSA can result in decreased length of stay, lower morbidity rates, and decreased cost of hospitalization. A hospital concerned about patient satisfaction can see the value that private rooms have to offer when it comes to reducing MRSA exposure.

Proper hygiene is also of major concern where nosocomial infection is concerned. Unfortunately staff members are usually to blame for spreading infectious microorganisms from one patient to the next. Studies have shown healthcare professionals are more likely to perform hand hygiene between patient rooms rather than between beds in the same room (Bereket et al. , 2012). This is not necessarily due to a failing on the part of healthcare professionals, but a failing of healthcare systems utilizing semi private rooms.

Take this scenario for instance: a nurse is working with a patient in a semiprivate room when suddenly the bed alarm goes off on the neighboring bed. The roommate is an elderly female with Alzheimer's-dementia who recently fell at home and suffered a fractured hip. The nurse has already been in physical contact with one patient and now has to take action in order to prevent the roommate from falling. The nurse must act quickly to prevent a fall-related injury and does not have time to perform hand hygiene before assisting the roommate back to bed.

This nurse would not have been put in such a position had her patients been placed in private rooms to begin with. Standardizing the use of private rooms prevents situations such as the above from occurring, promotes proper hand hygiene amongst healthcare professionals, and protects patients from unnecessary exposure to nosocomial infection. Peace and Quiet Nosocomial infection is not the only issue having a devastating effect on patient satisfaction. In fact the most common complaints in hospitals today are noise related (Eggertson, 2012).

With patient satisfaction being of paramount importance hospital systems should be paying close attention to what bothers their patients. Loud roommates, visitors, medical alarms, and television sets can worsen an already noisy environment for a patient trying to get some much needed rest. Some patients need more frequent monitoring than others. A post-operative patient may need to have their vital signs checked hourly, a diabetic may need to have their blood sugars checked regularly, and a patient on a high risk infusion may need constant monitoring.

This can be extremely disrupting for the patient in the neighboring bed. Some patient's may also have numerous visitors, watch TV late at night, or be just generally disruptive to their neighbor. Private rooms may not address all noise complaints in the hospital, but will at the very least resolve those related to roommates. Considering this issue is the number one patient complaint in hospitals today it is guaranteed to increase patient satisfaction. In addition to being the number one patient complaint excessive noise has been proven to cause sleep disturbances in hospitalized patients.

Sleep disturbances result in increased lengths of stay, increased morbidity, and higher costs of care (Buxton et al. , 2012). Patients recovering from surgery or acute illness need undisturbed rest periods for proper healing. An unnecessarily extended, complicated, and expensive hospital stay caused by sleep deprivation is extremely detrimental to patient satisfaction. Private rooms increase the quality of sleep, reduce lengths of stay, decrease morbidity, and result in a lower cost of care. These factors result in increased patient satisfaction.

Noise-related issues in hospitals not only affect the adult population, but can have deleterious effects on the infant population as well. The neonatal intensive care unit (NICU) often places infants in nurseries where multiple babies are cared for in the same room. NICUs consist of high risk infants with varying degrees of illness. Some of the infants being cared for require constant monitoring and intervention. This can result in a very ill infant receiving care that involves noisy alarms, life saving machinery, and ongoing care-related activity. The result is sleep disturbances, increased tress levels, and compromised healing processes for all infants in the room. Placing infants in private rooms eliminates the noise concerns created by the delivery of care for other infants and facilitates family interaction with the ill infant (Feldman, 2009). This results in better outcomes for the infants and happier parents. Considering the fact that infants are not old enough to make decisions regarding where to seek medical treatment, it is necessary for hospitals to recognize that parental perception of infant care is of paramount importance to patient satisfaction.

Respecting Privacy Another large concern affecting patient satisfaction is related to patient privacy. In 1996 the U. S. Department of Health & Human Services (HHS) instituted the Health Insurance Portability and Accountability Act (HIPAA) in order to protect patient privacy (HHS, 2013). HIPAA violations can have a devastating effect on a hospital's financial health, with each violation resulting in up to $1. 5 million in penalties annually (AMA, 2012). In a financially unstable economy with reimbursement rates at an all time low these penalties can add to existing budget deficits.

Budget deficits in a healthcare system result in understaffing, which leads to disgruntled employees and higher patient-to-staff ratios. Understaffing leads to the degradation of patient care. A prime example of this is call bell response time. Patients do not appreciate having to wait twenty minutes for a staff member to respond to a call button. When there is a high patient to staff ratio the time it takes for staff to respond to each patient call lengthens. Unfortunately when hospital administrators make budget cuts, cutting staffing is usually where they begin.

Private rooms can help prevent HIPAA violations from occurring during the delivery of care, which can save a hospital millions of dollars in penalties, and allow greater financial resources for staffing needs. A financially healthy hospital can afford to keep a reasonable patient-to-staff ratio, which allows for staff members to deliver quality care in a timely fashion, and results in greater patient satisfaction. The financial repercussions of HIPAA violations are not the only concern when it comes to patient privacy. Patient perception of measures taken to protect privacy during hospitalization has a great impact on patient satisfaction.

Performing patient care while maintaining a patient's right to privacy is nearly impossible in a semi-private room. A study conducted by Juliet Whitehead and Dr. Herman Wheeler shows that patients define and conceptualize privacy by the following criteria: "Privacy of information, e. g. having one's conversation being not over heard. Privacy of person and body, e. g. not being viewed during one's private moments. Having one's own personal space. " (Whitehead & Wheeler, 2008). The very concept of sharing a room with another person makes it extremely difficult to conceptualize having personal space.

The delivery of care almost always involves private bodily functions and the sharing of private information. Privacy cannot be reasonably protected in the delivery of care when two patients share a room with nothing but a curtain separating them. Private rooms increase a patient's perception of the privacy they experience during their stay, which is of great importance in increasing patient satisfaction levels. The most common form of HIPAA violations occur when healthcare is being delivered to a patient in the presence of others without obtaining the patient's informed consent (Ziel, 2004).

In a semi-private room a nurse has to ask her patient if it is OK to discuss details of the patient's care in front of anyone who happens to be present at the moment. If the patient does not agree the nurse is required to provide a private setting in which to discuss, or deliver care. This means that if a patient is in a semi-private room the nurse is required to move her patient to a private area, or ask the roommate to leave while care is performed. In reality it does not happen this way in the hospital setting. Care is delivered regardless of whether or not there is a roommate present.

Nurses do ask visitors to leave the room while delivering care if a patient requests, but do not ask other patients to do so. This means that privacy violations occur multiple times a day to patients in semi-private rooms. The use of private rooms makes it much easier to deliver care while protecting patient privacy and thereby increases patient satisfaction. Conclusion With the ever growing research indicating that private rooms increase patient satisfaction it is truly a wonder why some hospital systems continue to argue against the switch to private patient rooms.

Whether by decreasing nosocomial infection rates, providing quieter environments, or increasing patient privacy the use of private rooms clearly has a positive impact on patient satisfaction. In an extremely competitive economy where patients have a choice where they will seek medical attention it seems only logical that patient satisfaction should be a top priority when considering the choice between private or semi-private rooms. Hospitals that chose to listen to their patient population will soon realize that private rooms result in greater patient satisfaction and return business.

References

American Medical Association (2013). HIPAA Violations and Enforcement. Retrieved from https://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/hipaahealth-insurance-portability-accountability-act/hipaa-violations-enforcement.page Bereket, W., Hemalatha, K., Getenet, B., Wondwossen, T., Solomon, A., Zeynudin, A., & Kannan, S. (2012). Update on bacterial nosocomial infections. European Review for Medical and Pharmacological Sciences, 16(8), 1039-1044. Buxton, O., Ellenbogen, J., Wang, W., Carballeira, A., O'Connor, S., Cooper, D., & ... Solet, J. (2012). Sleep disruption due to hospital noises: a prospective evaluation. Annals of Internal Medicine, 157(3), 170-179. doi:10.7326/0003-4819-157-3-201208070-00472 Eggertson, L. (2012). Hospital noise. The Canadian Nurse, 108(4), 28-31. Feldman, L. (2009). Patient safety. Private rooms becoming the standard in NICUs. Hospitals & Health Networks/AHA, 83(11), 10. Lorenz, S., & Dreher, H. (2011). Hospital room design and health outcomes of the aging adult. Herd, 4(2), 23-35. Skoczyńska, A., Sadowy, E., Krawiecka, D., Czajkowska-Malinowska, M., Ciesielska, A., Przybylski, G., & ... Hryniewicz, W. (2012). Nosocomial outbreak of Streptococcus pneumoniae Spain9VST15614 clone in a pulmonary diseases ward. Polskie Archiwum Medycyny Wewnętrznej, 122(7-8), 361-366. Stall, N. (2012). Private rooms: a choice between infection and profit. CMAJ: Canadian Medical Association Journal = Journal De L'association

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