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Hospitals stop clock for visitors

May 16, 2009 12:36 am

BY JIM HALL

Each evening at 8 o'clock at Mary Washington Hospital, a voice on the public-address system tells visitors, "We have reached the end of the visiting day. We ask that visiting be concluded at this time."

Meanwhile, downstairs at the atrium entrance, a curious thing is happening: Almost as many people are entering the building as leaving.

Visiting hours are over, but family and friends are still arriving to see patients.

The parade of after-hours visitors at the Fredericksburg hospital is symbolic of how hospitals have changed their thinking about visiting hours.

Many, such as Fauquier Hospital, Culpeper Regional Hospital and the new Stafford Hospital Center, have abandoned strict visiting hours altogether.

And others such as Mary Washington, with traditional visiting times, are more relaxed in their enforcement.

"As long as a patient wants visitors after-hours, why should we have a restriction on them?" asks Carla Adams, senior director of inpatient services at Fauquier Hospital in Warrenton.

The attitude at Fauquier and at other hospitals is that visitors are not a nuisance and can actually speed a patient's recovery.

As Dr. Donald Berwick of the Institute for Healthcare Improvement once asked, "Who is visiting whom?"

Doctors and nurses, not the families, are visitors in patients' lives, Berwick said.

Berwick estimates that most U.S. hospitals have liberalized visiting hours in recent years, at least on the medical and surgical floors.

Culpeper Hospital, for example, says simply: "Our patients may receive visitors 24 hours a day, seven days a week."

Culpeper began its flexible visiting hours in 2007. Fauquier started in 2006. Stafford Hospital opened three months ago with its own version of open visitation.

"We had the opportunity to open fresh and new," said Cathy Yablonski, administrator. "We decided that this was something important."

PROTECTING PATIENTS

Open visitation usually means that if patients are willing and able, they can have as many visitors as they want, whenever they want, and for any length of time.

Fauquier, for example, has recliners in each room that double as makeshift beds if visitors want to stay the night.

An important qualifier is that patients must be up for company. If patients are too sick or tired, visitors may be asked to return later.

At Fauquier, patients and nurses sometimes agree on a silent signal that the patient flashes when he or she wants to sleep.

"We tell them, when you've had enough, you let me know. I'll be the bad person and send them out the door," said Fran Norman, former director of the intensive care unit and now the performance improvement project director.

Security is also a concern. Open visitation at these hospitals does not mean that the buildings are wide open.

At Stafford, two of the three public entrances are locked at 9 p.m. The remaining entrance is through the emergency department.

After-hours visitors must stop at the security desk in ER, where guards give them a badge to wear. The guards then call upstairs to the patient floors to notify staff that a visitor has arrived.

At Fauquier, there's also an announcement on the public-address system asking visitors who will be staying late to go to a nurse's station for a badge.

"That way we know who's in the house," Norman said.

THE VALUE OF VISITORS

A 2004 study in the American Journal of Critical Care asked 62 patients in intensive-care units what they thought of flexible visiting hours. Their conclusion:

"Patients clearly see the value in having visitors and are very satisfied with a visiting guideline that is flexible."

Patients said that visitors provided comfort, relieved boredom, helped them understand what was happening, and helped nurses understand them.

On the downside, patients said they sometimes felt they had to entertain visitors and couldn't get the rest they needed.

Lawrence McDade made use of Fauquier's flexible visiting hours when his wife, Rose, was a patient there.

Rose McDade was hospitalized with a bacterial infection for three months, from February through April.

At first she was on a ventilator and dialysis, and during that period, McDade spent up to 12 hours a day with her. By being there, he said, he could give informed consent.

"That's not a situation where you would want them to say, stop by at 6 o'clock tomorrow," he said.

Later, when his wife got better, he arrived each morning and stayed until early evening.

As for the hospital's flexible-visiting policy, he said he is a supporter.

"It was wonderful for me and helpful for my wife," he said.

Staff librarian Craig Schulin contributed to this story.

Jim Hall: 540/374-5433
Email: jhall@freelancestar.com