THE MAGAZINE

Hospital Safety Not Child’s Play

By Michael Gips

A New Approach
Children’s Mercy—like many similar healthcare facilities—had a fairly unrestrictive access policy before 9-11. But driven partly by the changing threat environment nationally and partly by a few disturbing instances at the hospital, the security team decided after September 11 that it was time to abandon its come-and-go-as-you-please environment.

A new approach to restrict and regulate visitor, patient, and staff access control was designed by the security team, headed by Director of Security Dan Malaun. The revised program establishes numerous procedures for controlling entry into the facility, including sign-in requirements for visitors, protocols for special restrictions, and attention to instances or events that might create a risk of contamination.

The center also takes a layered approach, with additional controls at internal doors and the use of

CCTV for remote surveillance throughout. In addition, the center understood that the new protocols and equipment would require staff increases.

Monitored Entryways
Under the old system, patients, visitors, and staff could enter the main facility (on the main campus) from about 15 different doors. There was no feasible way to monitor and account for people coming in from so many different entry points, says Dan Arnett, assistant director of security at Children’s Mercy. At most, it was only possible to staff five sign-in posts (more on staffing and posts later).

The security team decided that it made sense to turn the remaining 10 doors into emergency-exit-only throughways. All doors already had magnetic locks that would release after 15 seconds of alarm, so they met the fire code standard and could be for emergency use only.

The team then had to decide which five doors would remain open. They considered levels of historical traffic flow and areas where immediate access was needed, including the emergency room. Accordingly, one of the selected doors is the entrance to the ER. Another is the entrance to the same-day surgery department, where children come for procedures such as tonsillectomies.

Two other doors are side by side at the main entrance to the main hospital. The fifth entrance is the door to the bridge which links Children’s Mercy to the Truman Medical Center—an acute care and outpatient center for both adults and children—across the street. At night, when traffic in the hospital slows, the five entrances are reduced to three: the two main entrances and the entrance to the ER.

Five entry posts, custom-made by the hospital’s carpenter, are stationed just inside these five doors. Each station has wheels so that it can be moved to accommodate changing patterns of influx into the building.

Each post is equipped with a computer, an in-house phone, and a clock. In addition, there are basic personal protection supplies, such as masks and gloves, in case officers are about to admit someone who might have been exposed to hazardous materials. (More on protocols for dealing with contaminated patients later.)

The south campus. Because the south facility is newer, designers took into account the need to minimize entrances from the outset. The south campus uses two mobile posts, one just inside the main entrance and the other inside the urgent-care entrance. There is a third door equipped with a card reader, and employees use their magstripe ID cards to enter there.

There are a few other exterior doors that are kept locked and are currently fire-exit-only doors. The building was built with plans for it being expanded, to include taking on more clinics and becoming a full-blown ER. As the building gets busier, more entrances will be opened, and guards will have to monitor these extra entrances.

Sign-In Procedures
Officers at public entrances require visitors to sign a log sheet and note their time of arrival and where they are going. In general, all visitors, even spouses of employees, must show a valid photo ID. But with a supervisor’s approval, exceptions may be made for parents or grandparents who have rushed to the hospital. The ID requirement may also be waived for someone with extraordinary circumstances, though that again would require a supervisor’s approval, Arnett says.

The sign-in sheet has been tailored to protect patient and visitor privacy under the Health Insurance Portability and Accountability Act (HIPAA): the sheet has a sliding protective cover that shields from view all previous information entered on it. Thus, a visitor sees nothing but the information he or she has written. Arnett explains that allowing visitors to see others’ sign-in information could reveal the presence and medical issue of a patient, which could violate HIPAA protections.

Officers next check to determine whether the patient to be visited has been admitted to the hospital. At least twice a day, the hospital prints lists of admitted, ER, and same-day-surgery patients, which are distributed to the sign-in posts. The same information can also be found on the hospital’s computer system, which guards can access from any sign-in post.

Visitors then receive a sticker imprinted with that day’s date, color-coded to indicate where on the premises they may go. For example, visitors to the ER get a red sticker, while guests visiting patients other than those in the ER get a green sticker. If an officer wants to place additional restrictions on where a person can go, he or she can write a specific location on the sticker. The ER sticker also has a large, superimposed “ER” on it “so there’s no mistake,” Arnett adds.

Arnett admits that the system is not ideal for long-term patients and their visitors. “We’d like to get them a more permanent badge,” he says, but that could lead to problems. “We’d have to worry about whether they’re still here, how to get the badge back,” and other issues.

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