Intended for healthcare professionals

Letters Should all patients have single rooms?

The elephant in the single room debate: keeping patients active

BMJ 2013; 347 doi: (Published 22 October 2013) Cite this as: BMJ 2013;347:f6333
  1. Julie Bernhardt, director1,
  2. Toby Cumming, exercise, cognition, and mood theme leader1
  1. 1AVERT Early Intervention Research Programme, Florey Institute of Neuroscience and Mental Health, Heidelberg, 3081 VIC, Australia
  1. julie.bernhardt{at}

The overwhelming trend in new hospital design is for single bedrooms. As Pennington rightly points out, single rooms increase privacy and allow for better sleep, as well as helping in the fight against infections.1 However, they can lead to isolation and necessitate different practices or systems for monitoring safety. Whether we choose single or multi-bed rooms in our hospitals, what is missing from current design and care models is serious consideration of how we can encourage patients to be more active to promote faster recovery.

Overwhelming evidence shows that bed rest is not an effective treatment for most conditions.2

We have studied where stroke patients go within a hospital ward, how active they are during the day, and how they interact with staff. Using direct observation (behavioural mapping) our group and collaborators have studied more than 800 patients in seven countries over the past 10 years. We consistently find that stroke patients are “inactive and alone” for most of the day during a critical phase of care, when the brain is primed for recovery and restoration of function.3 4

Another striking finding is that patients rarely move from being in or beside their bed.3 Because activity is a major driver of recovery, and our movement patterns and behaviours are likely to be greatly influenced by the built environment, it is important that the impact of the environment on patient and staff behaviour is a focus of research on healthcare design.

As we build more hospitals with single beds, let’s not lose sight of the importance of ensuring that patients (particularly long stayers) and families have access to spaces that draw them out of their rooms. Particular attention must also be paid to the staff, policies, and culture that make it possible for patients to be active participants in their care.


Cite this as: BMJ 2013;347:f6333


  • Competing interests: None declared.