washingtonpost.com
The prescription is privacy; Washington area's hospitals converting to private rooms

By Derek Kravitz
Saturday, October 9, 2010; 6:32 PM

Private hospital rooms were once considered the realm of the rich, the powerful and the well-connected. The more common experience involved a cramped space with only a flimsy curtain separating two or more patients.

Now patients are saying goodbye to their awkward hospital roommates and enjoying golden solitude.

The next-generation room being designed at many of Washington's nearly two dozen acute-care community hospitals will be single-patient spaces - outfitted with flat-screen televisions with updated patient information, big bay windows to bring in natural light, soothing earth tones and a couch where family members and friends can rest.

Consumer demand for private hospital rooms has spurred hospital renovation and construction projects across the region in the past decade, while research outlining the health benefits of privacy and noise reduction have gained notice. A Washington Post analysis of 23 existing or planned hospitals in the Washington region found that nearly all of the facilities have either already converted to all private rooms or are in the process of doing so.

The renovation projects are not drastically increasing the number of hospital beds in Washington. Rather, hospitals are shifting their patients to new, larger rooms as they update many older medical buildings that were built after Medicare was introduced in the mid-1960s. Hospitals say the old rooms simply cannot accommodate the glut of new technologies and equipment. And as hospitals have gone "private," their competitors have worked to keep up.

All told, the cost of Washington's ongoing hospital construction and renovation projects total at least $2.1 billion, according to the Post analysis.

"Hospitals that have built new facilities in the past four or five years have built all private rooms," said Patrick Walters, senior vice president of strategic planning and system development at Inova Health System, Northern Virginia's largest hospital group. "So while we are partially all-private rooms, we are not way ahead, beating up on our competition."

Inova is embarking on the largest expansion and renovation in its almost 50-year history. At its main Fairfax campus, Inova's flagship facility, built in 1961, an $850 million project includes a new general hospital tower and women's hospital. With 833 beds, Inova Fairfax is the largest hospital in Northern Virginia and its only Level 1 trauma unit, which means it can treat any type of injury, no matter how serious.

"The public is really savvy now, and patients are starting to realize they can, and deserve, to be treated well," Walters said. "Almost everyone that comes in says, 'If you have [a private room], we'd appreciate it.' "

'I like my privacy'

Nadine Steward, 80, of Springfield spent 10 days at Inova Fairfax's Heart and Vascular Institute after complaining of shortness of breath during a doctor's visit for her ongoing cancer treatment. Housed in a six-year-old facility near the main hospital tower, the Heart and Vascular Institute is similar to what the new general-care patient rooms will look like: windows looking out on manicured gardens, a couch for family and friends, a private bathroom.

"My family comes and visits; it's quiet. I watched the Redskins game on Sunday," said Steward, who left the hospital Wednesday for at-home hospice care. "I like my privacy."

Inova's new 11-story, $161 million south patient tower will include 174 all-private intensive care and surgical patient rooms. Construction began in late September and is scheduled for completion in the fall of 2012.

A $400 million women's hospital will be built afterward, and the existing general medical tower and children's hospital will undergo $200 million worth of renovations, officials said.

Inova is using debt to pay for up to half of the project and dipping into cash reserves to cover the rest. The company reported about $2.1 billion in revenue and $150 million in operating profits in 2008.

"This is the golden age for the patient and the private room, and it will only get better," said Debra Levin, president and chief executive of the Center for Health Design in Concord, Calif. "Health care is evolving and so, too, is the way we look at where we stay."

A changing landscape

Elsewhere in Washington, the surge in private-room construction is going strong.

In Bethesda, Suburban Hospital's $230 million campus expansion and renovation project, called Suburban 2020, is awaiting Montgomery County zoning and planning approval. Prince William Hospital, a 170-bed facility in Manassas, is examining how to "maximize the number of private rooms," said Donna Ballou, a hospital spokeswoman.

Even Washington Hospital Center, the area's biggest hospital, with 926 beds, is now majority private rooms and could add more in the future, said spokeswoman So Young Pak. The hospital has long been recognized as the region's leader in providing deluxe private quarters. It opened its first VIP wing, with soundproof suites and hotel-like amenities, in 1968.

The 187-room Reston Hospital Center and the 342-room Virginia Hospital Center in Arlington both switched to all private rooms several years ago. Suburban, built in 1943 and one of the area's oldest hospitals, and Holy Cross Hospital in Silver Spring are in the early stages of large-scale renovations that will turn nearly all of their semi-private rooms into private ones. Inova's five hospitals in Northern Virginia, Sibley Memorial Hospital in Northwest and Montgomery General Hospital will be all-private by the end of the next decade.

And the region's three future hospitals - in rural Clarksburg in Montgomery County, near Sterling in growing Loudoun County, and on the Montgomery College campus in Germantown - will have only private rooms.

"The health-care construction industry here is still going," said James C. Wilmot, a partner with the Gaithersburg architectural firm Wilmot Sanz, which is working on three of the Washington hospital renovation projects. "We're as busy as ever."

However, Prince George's Hospital Center in Cheverly, which has faced financial difficulties in recent years, has no current plans to increase its private rooms, officials said. It did recently expand its emergency facilities.

In a time of shrinking resources - and a national slowdown in hospital construction - investments in private rooms and decor could be perceived as a waste, especially as the health system deals with the needs of the uninsured and an aging populace.

The biggest potential concern: that sorely needed money is being funneled for design elements that are unproven. Although research linking design elements and better patient health are well documented, few studies have been done as large-scale clinical trials, the type of research needed for scientifically credible results.

The American Society for Healthcare Engineers, part of the American Hospital Association, has supported the introduction of features in hospitals such as ceiling-mounted lifts to help move patients but has warned against using new innovations as a marketing strategy.

"The research is still very much in its infancy," said Levin, of the Center for Health Design. "There's a potential that hospitals could use it for business purposes. It is a business after all. But it's also means better care for patients."

Documenting the effects

Much of the research into how hospital spaces affect health is the result of a rapidly growing field of behavioral science and architecture dubbed "evidence-based design research." The research has documented links between private rooms and better survival rates among bone-marrow transplant victims and patients in burn unit, among other results.

Roger S. Ulrich, an architecture professor at Texas A&M University and a faculty fellow at the Center for Health Systems & Design, which pioneered hospital room studies in the mid-1980s, said increased construction costs associated with such design elements have "paid for themselves in lower numbers of infections, fewer patient falls and smaller numbers of nurse and physician injuries."

"A single room is the most important design aspect for better patient care," Ulrich said. "The attitude of viewing patients as objects has shifted. Hospitals are now in the consumer service business."

Some of the changes are already on display at Inova. Custodians stopped buffing and waxing the eighth floor of Inova Fairfax's main tower after research showed that patients with dementia and macular degeneration benefited from less glossy floors.

"People notice the floors, maybe not consciously, but they almost instinctively recognize it," said Chee Taylor, a former nurse who now oversees Inova's renovation and construction projects.

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