NOMINATION SUMMARY
As part of Morristown Medical Center’s mission to improve the patient experience, a group of clinicians, administrators and trustees evaluated policies and decided restricted visitor access were not viewed by patients as constructive. With patients staying an average of nearly five days in the hospital, set visitation times – often from 11 a.m. to 8 p.m. – can pose a challenge for those who work daytime jobs while juggling other responsibilities. Since friends and family members are increasingly seen as patient advocates and play a crucial role in patient recovery, the medical center eliminated set visiting hours and, instead, made visitation available 24/7. We did so to benefit our patients and their caregivers who play a critical role in the healing process.
NARRATIVE
Hospitals typically restrict visiting hours to ensure a restful environment for patients and to allow clinical staff to work. With increased public reporting focused on patient satisfaction and renewed efforts to improve patient and family engagement, Morristown Medical Center, a 687-bed Atlantic Health System facility located in Morristown, NJ, initiated a 24-hour visitation policy. Liberal visitation practices can decrease patient anxiety and benefit patients and families.
Prior to the design and implementation of the program, focus groups were conducted with staff to get input into how this process might work. By engaging nurses, physicians, administrators and hospital security in its design, a plan was created to place the patient at the center of decision making – supported by the nursing and medical staff and enforced by security.
The hospital received nearly 14,500 visitors during the eight month evaluation period. We found that an overwhelming 83 percent of patient visits occurred between 8:00 p.m. and 10:00 p.m. Despite the significant surge in visitors after traditional visiting hours, the hospital operated status quo – no additional staff were needed to manage the night time visitors.
Each patient has the right to determine who including spouses, domestic partners (including same-sex domestic partners), other family members, friends or a surrogate may or may not visit. If the patient granted permission, the visitor was issued a pass by security after being screened. Additionally, families and patients had favorable opinions about the new policy and the flexibility to see loved ones when it was convenient for them. Visitors and patients praised the program in the Hospital Consumer Assessment of Healthcare Providers and Systems survey, a standardized survey that measures patients’ perspectives on hospital care. The study results were published in the Journal for Healthcare Quality in August 2013.
Implementing this open visitation policy is a win-win for all parties. Patients are allowed to more spend time with their loved ones, which helped promote the physical and mental healing process; visitors become a valuable asset to hospital staff as they grew more cognizant of patient changes; and nurse managers receive fewer phone calls requesting patient updates. As a result, a patient-centered, 24/7 open visitation philosophy was fully adopted by Morristown Medical Center and its sister institutions, Overlook Medical Center in Summit and Newton Medical Center in Newton, which are part of Atlantic Health System.
We credit our success to creating a process to control visitor access during off-hours and creating a partnership between clinical staff and hospital security; both are essential.
RESULTS
With input from nurses, physicians, administrators and security, we developed a policy that emphasizes patient and staff safety, and places the patient at the center of decision making. Comparison of patient satisfaction scores before and after the open visitation policy was implemented, which was made using the chi-square test. In the first eight months of the new policy, the medical center received 14,444 “after-hours“ (8:00 pm -5:00 am) visitors. During this period, there was no increase in the number of complaints from patients or visitors. Incidence of security events did not change despite the higher number of visitors. Patient satisfaction scores rose on both a commercial satisfaction survey and on the Hospital Consumer Assessment of Healthcare Providers and Systems survey. Unit staff received fewer phone calls for patient updates and acknowledged that the experience has been positive. Families expressed positive comments about the ability to see their loved ones before going to work. Our experience suggests that implementation of open visitation at acute care and long-term care institutions can be accomplished with little disruption, is well utilized by visitors and improves the patient and family experience. Supporting patients in a way that allows them to be with family and loved ones can be an important component of healing and may reduce the anxiety and social isolation associated with illness.
