Extremely vulnerable and in hospital. Should she be in a single room?

[roguenjo]

An elderly relative has chronic leukemia so has regular chemotherapy and is extremely vulnerable to contracting any infection, not just Covid. She has now been admitted to hospital for a separate issue and has been put in a 6-bed ward. Would it be reasonable for me to phone and ask whether there is a single room she could be moved to, or should I just assume she would have been given one if there was one available? I know she's probably not the only one in that position, so how do they decide who gets the private rooms? Are they just for people with private medical insurance? For context, it's a Tier 3 area so no visitors allowed.

You could ask but I suspect they won't have one. I would think the risks are significantly reduced if no visitors are allowed though.

You Used to be able to pay for a side room subject to availability. I think at the moment they are allocated based on cross infection risk including Covid, end of life and with conditions which cannot easily be accommodated on a shared ward. It is worth asking though.

In the nhs hospitals I've worked in single rooms or cubicles are for patients with infectious diseases. For example d+v, flu etc. Also for patients that need to be reverse barrier nursed eg neutropenic sepsis. There's usually 4 of these per ward ime.
There's no harm in asking especially with your relatives pmh. However like a pp said infection risk is low due to restrictions and the cubes can also be quite lonely for patients

They also try and keep them available for patients receiving end of life care aswell. Especially at the moment so they can have family around them without putting other patients in the bays at risk. Hopefully they can figure out a solution for you

I was in hospital recently for a horrible post op infection and I fall into the group that was shielding. I was moved to a side room after a day or so on the insistence of the ward sister for better infection control so definitely not just for private patients.

Even if there isn't a room available, they should be taking extra precautions (for me that was keeping the curtains drawn, full apron, mask and gloves from anyone coming anywhere near me). Our trust also display an 'infection control' warning poster.

Unfortunately, side rooms are precious.
There is of course no harm in asking the question, but I expect the answer would be there are people who need them more at the moment.

From my impression of being in a general surgical ward with "dubious" Covid status (I had a temperature pre admission) they are tending to prioritise keeping riskier patients in single rooms - so those awaiting swab results or potentially infectious. These patients are then moved to general areas once they have a negative swab.

Depending on type of ward they might only have enough single rooms for barrier nursing "potential Covid" and not anyone else.

I agree it's not ideal - when I was in the first time (July) they definitely had people in single rooms who weren't there because of their risk to others, in September I think single rooms were being kept for receiving people until they could triage properly/check various obs...

Not ideal!

Only time Iv been in a side room was when I was infectious. I think that’s what they are mostly used for.

I've got stage 4 lymphoma and have always had a side room due to my vulnerability on picking up and infection. Although this has been specifically on cancer ward. So unless her levels are in good shape then only reason I can think of is a lack of availability.

Even when I was admitted via A&E one time they kept in a side room in A&E to keep me safe

It'll depend on her current blood counts (as it's a separate issue, rather than a haematological one that has landed her there)

And yes it's likely she will be priority for a side room when one becomes available.

I hope she's better soon

I was put in a side room when I had high fever & they had no idea what was causing it. There will be lots of people like your relative, OP. All very vulnerable but can't be prioritised into single rooms. You can ask, but don't have high hopes is my advice.

I was put in a side room when they though I had meningitis (turned out I didn't but that's another story). I was so blooming ill I neither noticed or cared I'd been assigned such luxury. I think they keep them for the infectious mainly but really I'd expect your aunt to have one if it were at all possible.

It must be a difficult balance - x number of side rooms, y number of infectious patients and z number of very vulnerable patients - who goes where?

The key with side rooms is that you prioritise people who could infect other people - otherwise, before you know it, you have a whole ward infected. However, if someone has no immune system, they also get priority.

Every hospital will have a bed manager, whose job it is to look after the entire hospital bed system. So they will know which patients need side rooms, which patients have D&V, Flu, Sepsis, etc., and whether they are male and female.

If required, they will cohort patients into bays who have similar infections. For example, they could have a C.Diff bay on a ward, which is shut off from the rest of the ward.

Your relative will be having blood tests, which will tell the doctors what level of urgency is used to isolate them. Even on a normal ward, they can do limited isolation, where they shut the bed curtains and people have to glove/gown/mask before entering. It's not quite the same as a side room, but it does offer a small layer of protection.

I'm permanently neutropenic and always in a side room. I don't wait in a&e waiting room either, straight into a cubicle

They won’t have any beds. That’s my guess. So sorry.

Hospitals should be build with many, many more private rooms. Ward nursing should be a relic of the past, possibly with the exception of dynamic Intensive Care.

Our local hospital (NHS) is all single rooms. There was a lot of opposition to that layout when it was being built, a couple of years ago, but it surely makes for a much safer environment for infection control.

I have chronic leukaemia (CML - is that the same as your relative?)

I carry a card permanently about the high risk of neutropenic sepsis. She should be regularly monitored for signs of infection and blood counts and films done (not sure how often, might depend on what she is in for)

If she is not neutropenic, and if her leukaemia is well under control, she’ll be fine in the main ward. Has she been admitted to the same hospital as where she had her haem treatment? Does her haem consultant know she’s in?

She will be priority for a side room, but she probably isn’t the only one with priority and it is quite possible she is safe on the ward

But definitely worth asking if they will move her if a bed becomes available, and what happens about moving her if there are adverse changes to her blood counts

I used to work on a haematology ward and second what @iVampire says. It depends on her count of white blood cells called neutrophils. If they are below normal, especially if below 0.5 she should be in a side room.

Side rooms in normal wards are actually less safe than bay nursing, in terms of noticing a decline in condition. It's different in HDU/ICU where the ratio is 1:1 or 1:2, but on a normal ward, I'd rather be in a normal bay if I was a patient at risk of deterioration, tbh.

My mum’s in a private room because she’s on chemotherapy. It’s worth an ask x

@whataboutbob

I used to work on a haematology ward and second what *@iVampire* says. It depends on her count of white blood cells called neutrophils. If they are below normal, especially if below 0.5 she should be in a side room.

@whataboutbob, she knows her neutrophils from her last clinic visit, they're zero. But she's in an ENT ward and they haven't tested that - she told the nurse, but not sure if they've clocked it.

I'd be worried for anyone with leukemia being on an open ward but sometimes they just don't have the side rooms available. I think you should ask but expect to be told they may not have any. Is there any reason she would need to be in a bay for safety/ supervision reasons. is she confused or wandering?

Thanks all. You gave me the confidence to phone the ward and when I explained the situation they immediately said they would move her to a side room. Now feeling quite cross that they didn't pick it up earlier.

@ScienceSensibility

Hospitals should be build with many, many more private rooms. Ward nursing should be a relic of the past, possibly with the exception of dynamic Intensive Care.

private rooms???

Don't you mean 'single' rooms?