Intended for healthcare professionals

Letters Should all patients have single rooms?

Risk of inpatient falls is increased with single rooms

BMJ 2013; 347 doi: (Published 22 October 2013) Cite this as: BMJ 2013;347:f6344
  1. Inderpal Singh, consultant physician and geriatrician1,
  2. Justin Okeke, specialty registrar, geriatric medicine1
  1. 1Ysbyty Ystrad Fawr, Aneurin Bevan Health Board, Ystrad Mynach CF82 7GP, UK
  1. inder.singh{at}

We recently compared a newly built Welsh hospital that has 100% single rooms with the old hospital, which has both single rooms and multi-bedded wards. In agreement with Pennington, we found that single rooms reduce the incidence of hospital acquired infections.1 Rates of acquisition of Clostridium difficile were also lower in the new hospital.2 As part of our study, the all Wales fundamentals of care audit showed that compliance with healthcare standards was similar between sites (94.9% and 92.5% at the old and new sites, respectively). In addition, a patient satisfaction questionnaire at the new site showed 94% satisfaction—patients agreed that they had received dignified care and that privacy was maintained at all times.

Although we agree with Isles that older people have reported isolation in single rooms, where they could be for some time, he did not discuss the increased risk of inpatient falls in the single room setting. The most important impact of 100% single rooms that we saw was a significant increase in such falls. The incidence of inpatient falls at the old site was 6.75/1000 patient bed days, which increased to 16.79/1000 patient bed days (incidence rate ratio 2.49; P<0.001) with 100% single rooms.2 This phenomenon has been reported previously.3

We support the need for more single rooms because they increase patients’ dignity, privacy, sleep hygiene, and confidentiality, as well as reducing hospital acquired infections. But there must be a balance between single bedded and multi-bedded bays. Hospitals with 100% single rooms should not be built at the expense of increased patient risk, and hospital design should take patient cohort, age, and medical specialty into account.


Cite this as: BMJ 2013;347:f6344


  • Competing interests: None declared.


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