The Effectiveness of Visitor Management in Hospitals


This report offers a snapshot of the visitation policies and visitor management approaches of participating IAHSS members’ institutions sampled in September and October, 2018. In total, 135 facilities were included in the survey analysis. The sample included 37 facilities with 500 licensed beds or more, 55 facilities with 200-499 licensed beds, and 43
facilities with 200 licensed beds or fewer. Among participating facilities, 54% were teaching hospitals, 78% were located in urban settings, and 10% were located outside of the United States. Approximately 65% of respondents reported that their annual security budget was $500,000 or greater. Ten of the survey respondents also participated in a one-on-one telephone interview with a member of the research team.

A mixed method approach was selected to identify, evaluate, and contextualize facilities’ current visitor management programs. A cross-sectional, online survey was administered to hospital safety and security administrators to capture information on their facilities’ visitation scheduling and visitor management protocols as they related to safety and
security. Then, a set of 10 key informant interviews was executed to collect additional details about the visitor management programs’ structures, effectiveness, and issues.

Among responding organizations, 81% had a facility-wide visitation policy, of which 55% had a policy of unrestricted or open visitation (i.e., facility-wide visitation policies that allow patient visitors 24-hours per day, seven days per week, in general). The mean costs to implement (one-time) and maintain (annually) the facility’s current visitor management program were $154,292 and $44,196, respectively. Specific visitor management practices tended to vary by facility attribute; facility square footage, number of licensed beds, in-patient census, whether the facility was a teaching hospital, and whether the facility had a facility-wide visitation policy were each positively associated with more rigorous visitor management practices.

Slightly more than one-third of facilities reported a total 12-month security call volume of fewer than 3,500 calls, and one-fourth of facilities reported a total 12-month security call volume of more than 17,500 calls. Among hospitals with more than 500 beds, 77% reported more than 10,000 calls annually, and 37% reported 50,000 calls or more. Disorderly conduct calls were the most frequently reported type of call, overall. Annual call volumes increased as facility square footage and the number of licensed beds increased; higher call volumes were also evident among teaching hospitals, urban hospitals, and facilities with electronic visitor management systems. Factors associated with increasing categories of call volume were in-patient or emergency department patient censuses, having 500 or more licensed beds, and having an electronic visitor management system.

No differences were seen in the number of security calls reported overall between facilities with and without facility-wide visitor management policies. When comparing hospitals with open visitation to those without, no statistical differences were seen in terms of 12-month total call volume or call volume by specific type of call (e.g., disorderly conduct, assault, theft), with the exception of battery and robbery. Among facilities 5
reporting security call volumes before and after implementing open visitation, 88% indicated that their total annual call volumes did change following the transition. Additionally, no statistical differences were seen in terms of 12-month total call volume or call volume by specific type of call when comparing facilities with and without electronic visitor management systems.

Slightly more than half of respondents indicated that their facility’s visitor-related security issues had become more challenging over the past 12 months; fewer than 5% reported that their issues had become less challenging. Among open visitation facilities, the majority indicated that their visitor-related security issues had remained about the same prior to and since implementing open visitation. Interview participants generally
expressed a desire to increase the rigor of their visitor management and facility access control, which they indicated were more pressing issues than visitation scheduling. Facilities requiring visitor registration (or more stringent visitor management practices) reported generally positive public responses to increased levels of security scrutiny. Facilities’ safety and security efforts could benefit from future research that promotes the
collection of standardized information related to crime, violence, and victimization, broadly, with a particular focus on collecting objective data prior to and following the implementation of policy or practice changes. Given the influence of month, day-of-the week, and time-of-day on security issues, future studies examining temporal trends would be valuable, particularly for staffing purposes. Future research could also assess the
effectiveness of specific visitor management policies and practices and conduct efficacy, translational, and dissemination research on interventions that promote hospital safety and security based on the findings of those assessments.

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