[NYAPRS Enews] Expanding Hospital Visiting Hours Critical to Engagement, Discharge Planning Efforts: CHP

[Harvey Rosenthal]

NYAPRS Note: Among the greatest impediments to helping people to break the cycle of frequent hospital readmissions are the barriers that limited access onto the units pose to rapid engagement and timely support for successful self-directed discharge plans. Our peer bridgers have historically had great difficulty in getting onto local hospital units outside of limited traditional late afternoon and evening visitor hours. Per NYPIRG's Megan Ahearn, "morning visitation hours can be particularly important because it's during that time that many staffing changes occur and daily rounds and health care decisions are made. To have your support person there when that's happening is really helpful."

Hospitals Improving on Visitor Policies, But More Work Needed
By Jennifer Henderson  Crain's Health Pulse November 8, 2019

The New York Public Interest Research Group and New Yorkers for Patient and Family Empowerment on Thursday released the results<https://www.nypirg.org/pubs/201911/Sick_Scared_Separated_2019_web_FINAL.pdf> of a two-year survey of visitation policies at 40 hospitals across the state, finding that improvements have been made, but there is more work to be done.

The work is aimed at transitioning hospitals away from arbitrary limits on visitation and toward participation of family caregivers or designated care partners consistent with patients' wishes, NYPIRG said.

In line with that goal, more than two-thirds of the hospitals surveyed were found to provide 12 or more visiting hours per day, with 17 of those hospitals now offering 24-hour open visitation for general medical and surgical units, NYPIRG said. Additionally, 18 of the hospital websites posted clear statements encouraging patients to designate caregivers or care partners.

Of the hospitals that participated in a training program from the Institute for Patient- and Family-Centered Care to improve their visitor policies, those that took part as a group tended to perform better.

For instance, Northwell Health's hospitals performed particularly well on that front, said Megan Ahearn, program director of NYPIRG. "When a whole network joined in on the project, you could definitely tell the improvements happened more efficiently and took on some of the best practices," she said.

At the same time, seven hospitals surveyed posted policies that significantly restricted patients' access to family caregivers or designated visitors, NYPIRG said. And none of the hospitals received a perfect score on website communications, the primary source of information for the public and prospective employees.

"Research has shown that when patients have access to a network of loved ones and the ability to choose a partner in their care, not only do they have a better experience and higher satisfaction, but they also have better health outcomes," Ahearn said. There is a need to move to 24-hour visitation policies, she added.

A review of the training program used as part of the survey showed that the creation of more open visitor policies was associated with lower hospital infection rates, Ahearn said. Other benefits include having a support person who can help patients understand their care plans and medications and transition smoothly out of the hospital to reduce readmissions.

"As hospitals move toward 24-hour visitation policies, we definitely want to see more morning hours," Ahearn said. Morning visitation hours can be particularly important because it's during that time that many staffing changes occur and daily rounds and health care decisions are made. "To have your support person there when that's happening is really helpful," she said.

In general, some hospitals' concerns with moving toward 24-hour visitation policies include difficulty in obtaining buy-in from leadership and staff, Ahearn said. It can take a lot of effort to explain how and why a policy is changing.

Additionally, there has been concern over potential disruption in wards including the intensive care unit, such as increased stress or obstructions to getting to patients in need of urgent care or resuscitation, she said. But some research rebuts those concerns.

"When you look at what happens in real time, having a more inclusive visitor policy has not been a hindrance to really great care and has not reduced health outcomes," Ahearn said. Hospitals should, however, prohibit visitors who are sick and contagious. And they should consider in cases of shared rooms that what is an advantageous environment for one patient may be disruptive for another.

Ultimately, "no one should be alone in the hospital," said Suzanne Mattei, project director of New Yorkers for Patient & Family Empowerment, in a statement. "The most important step a patient can take for safety is to choose a trusted family member or friend to be in the room, paying attention and asking questions as needed."

Support for the work was provided by the New York State Health Foundation.



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