Hospitals relax visiting rules, some say to please families

By Kim Hilsenbeck.

Hospitals have rules – for good reason – especially in critical care and other specialized units such as the Intensive Care Unit (ICU).

Restrictions on numbers of visitors, hours and allowing children are considered when developing hospital policies. Those policies balance rest, limiting the spread of infectious diseases and allowing staff to perform their duties with a patient’s wishes to be with their loved ones.

At local hospitals, some rules have become more relaxed. Hospital leaders say it’s by design.

Seton Medical Center Hays (Seton Hays), the largest hospital in Hays County, has non-critical care visiting hours from 8 a.m. to 10 p.m. 

For specialized areas, such as ICU, hours differ, as do some rules, according to Adriane Lallo, a Seton spokesperson.

“It was a deliberate decision by Seton hospitals to offer more patient-centered care,” she said.

Not that many years back, Neal Kelley, Seton Hays CEO said things were different.

“Seton’s ICUs and CCUs used to be very closed off units. They allowed one visitor and only at certain times of the day.”

He also said children were not allowed in specialized care units.

Down the road at Central Texas Medical Center (CTMC)in San Marcos, spokesperson Clay DeStefano said ICU visitors are allowed in during four time periods daily. 

“As recent as five years ago, we still had very stringent hours and rules,” DeStefano said. “Only one family member was allowed at a time with restricted access to the unit.”

Kelley agreed that this approach has changed over the past five to 10 years. Seton reconsidered its strict visitation policies in part, he said, because patients and families asked for more access.

“Today we are much more open,” he said. “It’s a balance between patient experience and being allowed to be with the loved one, especially during critical times.”

By design, Kelley said, specialized care units are restricted and the Seton staff uses their best judgment, including the patient’s status, physician input, susceptibility to infection and a patient’s wishes.

It’s the possibility of the spread of infection and the bustle in specialized care units that have some local nurses concerned.

A Hays County nurse who has worked in several area hospitals, said she has seen Seton Hays relax its ICU policies. Allowing children in is of particular concern, she said, citing the possible spread of infection coupled with additional noise.

The nurse also said some managers give in to the wishes – or complaints – of family members against the advice of a patient’s nurse. 

The nurse is concerned about lengthy visits by family, because newer hospitals build and furnish larger patient rooms to accommodate more family members.

She said the concern is not about a spouse or trusted family member staying with a patient. She believes every patient needs an advocate. Rather, the issue stems from large families visiting for extended periods, exhausting patients.

Kelley, a nurse by training, said Seton maintains an appropriate environment, including limiting visitors, keeping noise levels low and limiting the spread of infection.

Inside the Seton Hays ICU, nurse and unit manager Francesca Damiano Hammond said physicians, nurses, the patient and family members are involved in setting visitation policies.

“It’s all about care and com-passion,” she said.

Damiano Hammond said some patients, after surgery for example, might not want children in the room.

“A lot of times, it’s the families that want children to come in to visit, not really realizing what they’re asking,” she said. “If [the patient is] cognitive, ultimately, it’s their decision.”

But DeStefano said research shows patients heal better when they interact with loved ones.

“Like many other hospitals, we’re adapting to that new science,” he said.

But the nurse who has worked at Seton Hays and CTMC, said she is not convinced that it’s only the research. 

She said payments from Medicare are in part based on patient satisfaction. And since the surveys are mailed to patients after their visit, no one really knows if it’s the patient or a family member who completes the survey.

A few years ago, DeStefano said healthcare reform led to changes in hospitals reim-bursement.

“Medicare and Medicaid are looking at what they will and won’t pay for,” he said. “They pay based on how satisfied a patient is.”

He said that’s one reason family are so important. 

For hospitals like CTMC, that means looking at visitors in a new light.

“The goal is to make everyone comfortable,” DeStefano said.

Overall, DeStefano said insurance companies drive hospital reimbursements. 

“They define who is allowed to be hospitalized and for how long; for example, new moms are staying 48 hours, some are let out in 24 hours,” he said.

DeStefano said CTMC’s satisfaction scores have been very positive, typically near or above 97 percent. 

Kelley said Seton satisfaction is also generally at 97 percent or higher.