The classic saying may need some readjusting — actual medicine may edge out laughter for the top spot, but it’s still an important second place. A new study has found that hospitals may see greater overall patient satisfaction if they were to remove all visiting hour restrictions, as the comfort of family and reduced feelings of isolation make sterile hospitals seem a little more homey.
Published in the Journal of Healthcare Quality, the peer-reviewed publication of the National Association for Healthcare Quality (NAHQ), the case study investigated one New Jersey hospital, Morristown Medical Center, for a period of eight months between March 2012 and October 2012. In that time, 14,444 visitors passed through the hospital during “after hours,” between 8:00 p.m. and 5:00 a.m. According to the researchers, patient satisfaction rose while staff and visitor complaint remained virtually nil.
“Our experience suggests that open visitation at both acute care and post-acute care hospitals can be accomplished with little disruption and improve the patient and family experience,” Dr. David J. Shulkin, lead author and president of Morristown Medical Center, said in a news release.
While many European hospitals have already adopted the practice of 24/7 visitation hours, Dr. Shulkin points out, the tendency among American hospitals to limit visitation sometime around 8:00 p.m. is counter-productive. Though it’s usually to minimize the nightly load put on the hospital staff and ensure patients receive adequate rest, Dr. Shulkin argues patients should have more choice in whether they have visitors during night hours. Patient autonomy and personal justice should determine how and when their family visits, proponents claim, not the hospital itself.
“Supporting patients in a way that allows them to be with family and loved ones can be an important component of the healing experience and may reduce the anxiety and social isolation associated with illness,” Dr. Shulkin explained.
But what about the staff? Surely, nearly 15,000 more visitors would make nightly routines run much more slowly, as people clog up the hallways and interrupt treatment schedules. As it turns out, a 2011 study found that nurses, too, favor the policy of open visiting hours — that is, visiting hours that run 24/7.
“Research indicates an open visiting policy may improve the quality of care and satisfaction of patients, family members, and nurses in the intensive care unit,” researchers involved with the study wrote. “The studies reviewed show that although most critical care nurses find that open visiting hours may impede patient care, the benefits to patients and family outweigh any negative impact to the patient.”
Now more than ever, the present study authors argue, family and friends are becoming patient advocates. Relatives and loved ones like to play a more integral role in rehabilitating the patient, assisting in his or her recovery as much as the bedside heart monitor. In this, the focus is patient-centered. Hospitals that have open visiting hours tend to put the patient first, which means the patient’s friends and family are shown preference to the convenience of restricted hours.
At the same time, hospitals must be strategic in how they execute the policy, as security risks are expectedly higher during after-hours. “By requiring all visitors to enter through a single location and provide identification, and by security and off-hours staff cooperating to report suspicious behavior, we were able to minimize security risks,” the authors wrote. “Calling to the patient care unit to ensure that the patient wants to receive a visitor at a particular time is also important.”
In the end, Dr. Shulkin says the idea hospital staff and patients wish to have a “downtime” from the daily hustle and bustle of visitors filing in and out is simply untrue. “Our staff did not find this to be a reality after we did away with visiting hours. In fact, staff found that patients and families were in fact helpful in creating a calming and healing environment. So in essence this was a myth,” he said. “There was no increase in workload.”
Source: Shulkin D, O’Keefe T, Visconi D. Eliminating Visiting Hour Restrictions in Hospitals. Journal of Healthcare Quality. 2013.